21-2-402. Voter’s certificates; preparation, forms, and procedures.

At each primary and election, the Secretary of State shall prepare and furnish to each superintendent a suitable number of voter’s certificates which shall be in substantially the following form:#

1. VOTER’S CERTIFICATE

2. I hereby certify that I am qualified to vote at the (primary or election) held on , that I have not and will not vote elsewhere in this (primary or election) in my own name or in any other name, and that I am a citizen of the United States and am not currently serving a sentence for a felony conviction. I understand that making a false statement on this certificate is a felony under Code Section 21-2-562.

3. Signature

4. Current residence address of elector:

5. Elector’s date of birth:

6. Name or initials of poll officer receiving voter’s certificate:

7. In case of physical disability or illiteracy, fill out the following:

8. Reason for assistance (Check appropriate square):

9. ( ) Elector is unable to read the English language.

10. ( ) Elector requires assistance due to physical disability.

11. Signature of poll officer

12. Number of stub of ballot or number of admission to voting machine:

The voter’s certificates shall be so prepared as to be capable of being inserted by the poll officers in a suitable binder for each primary or election. The binder shall have written thereon the words “Voter’s Certificates” and shall have a space for filling in the designation of the precinct and the date of the primary or election.#

The election superintendent may obtain or may create and provide other voter’s certificates, provided that such other voter’s certificates are in the form required under this Code section and are approved by the Secretary of State.#