State Codes and Statutes
Statutes > Utah > Title-20a > Chapter-06 > 20a-6-10520A-6-105. Provisional ballot envelopes.
(1) Each election officer shall ensure that provisional ballot envelopes are printed insubstantially the following form:
"AFFIRMATION
Are you a citizen of the United States of America? Yes No
Will you be 18 years old on or before election day? Yes No
If you checked "no" in response to either of the two above questions, do not complete this form.
Name of Voter _________________________________________________________
First Middle Last
Driver License or Identification Card Number _________________________________
State of Issuance of Driver License or Identification Card Number _________________
Date of Birth ___________________________________________________________
Street Address of Principal Place of Residence
______________________________________________________________________
City County State Zip Code
Telephone Number (optional) ______________________________________________
Last four digits of Social Security Number ____________________________
Last former address at which I was registered to vote (if known)
______________________________________________________________________
City County State Zip Code
Voting Precinct (if known) _________________________________________________
I, (please print your full name)__________________________do solemnly swear oraffirm:
That I am currently registered to vote in the state of Utah and am eligible to vote in thiselection; that I have not voted in this election in any other precinct; that I am eligible to vote inthis precinct; and that I request that I be permitted to vote in this precinct; and
Subject to penalty of law for false statements, that the information contained in this formis true, and that I am a citizen of the United States and a resident of Utah, residing at the aboveaddress; and that I am at least 18 years old and have resided in Utah for the 30 days immediatelybefore this election.
Signed ______________________________________________________________________
Dated ______________________________________________________________________
In accordance with Section 20A-3-506, wilfully providing false information above is aclass B misdemeanor under Utah law and is punishable by imprisonment and by fine".
"CITIZENSHIP AFFIDAVIT
Name:
Name at birth, if different:
Place of birth:
Date of birth:
Date and place of naturalization (if applicable):
I hereby swear and affirm, under penalties for voting fraud set forth below, that I am acitizen and that to the best of my knowledge and belief the information above is true and correct.
____________________________
Signature of Applicant
In accordance with Section 20A-2-401, the penalty for willfully causing, procuring, or
allowing yourself to be registered to vote if you know you are not entitled to register to vote is upto one year in jail and a fine of up to $2,500."
(2) The provisional ballot envelope shall include:
(a) a unique number;
(b) a detachable part that includes the unique number; and
(c) a telephone number, internet address, or other indicator of a means, in accordancewith Section 20A-6-105.5, where the voter can find out if the provisional ballot was counted.
Amended by Chapter 285, 2007 General Session
