Early Voters Roster 4-25-2023Voter Assistant (if additional voter assis(ant lines at-(.- uccessart', cul).tilt(tc tout (lie clack of this form) include Name.:liddress
I'lllc # Asisteme do Vol rotes (si lineas adiciouales still necesarias parts a.isre[um da cotantcs, con(inuc cq el let cisu de CSIe liunulfalio)
Inclaya lvrubrc, Qirccci6n
Location (Sitio) slate of Election (Fecha de elecci6n) I:ype of Election (•I ipo Cie elel:6611)
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County Precinct No. VULL) Poll List (Lism de Vo(antes)� Voter Address (Domicilio del Voti(li(e)
Num. do Piecincto
COMBINATION FORD and nesss mn,rx.can.mlar,rm � i{
y Roster for Early Voting eEarly Voting alairn}uolt lnaa ai rW,.ol nu c3 aun a.l ou0. ��`
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Cilw irAppGcablc) �larrtr si Corresnunde) If a voter is unable to sign his/her name, an election official shall place cite voter's name on
_ the signature raster and make a notation as to the reason the voter Is unable to sign.
Si algim votante no puctle finnar su Hombre, Lin oftcial electoral a luntar5 el Hombre del votante cu el
c ry rceistro de (irmas y itara tnta anuu ici6ii indicando la cama por la coal el votante no pudo linnur.
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VoterAssistant (if additional voter assistant lilies are necessary, continue on the hack of this forte) include \ante, Address
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Location (S�!itio) Date of Election (Fecha d� eleccicin) I type u€ Clection ("['ilao de �lt: C)c Il)
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County Precinct No. UIU Poll List (Lists cle Votantes) Voter Address (Domicilio del Votallte)
Num. de Precincto
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If a voter is tunable lit sign his/her name, an election official shall place the voter's name on
the signature roster and make a notation as to the reason the voter is unable to sign. .
Si algim volume nopuede finnar su nonibre, un oficial clectomi a ,unlara el nombre del volonle en ci
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regisiro III:tirmas y harai una anotalci6u indicattdo N causal pot I 1 cual el votante no pudo firmor.
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*AFFIDAVIT IY)R VOTER NOT ON LiST: By initialing; ❑te square labeled "Affidavit for Voter Slit till List," I shear or affirm that I (A) mu it resident of the precinct in which i ant offering to vote or min otherwise entitle!
b la \ to dl i t that n•ec'n • N as •s' o t • precinct ) • t \1 ct a i resident nt (11 trt hul i um offering to vo • : t • the • Information on t �residence• v t t th • tttnt 1 t n \ ad r ss is • s evi 1 a lu voter registrar, . ( )t td e ut . last provided t i C; did not deliberately rov d,
false iiilin•nultion N, secure rrgistrnttun hi a precinct in ss'hidt 1 do not reside, aml (D) mn voting; nuiy +nice in the elccfion. i
*JUItA'v18N"1'0 DE VOTANTG: N ftrmar con mis iniciales el cuadro marcado-Accpto lummento", yo dcclaro o alinuo que (A) soy residents del precimo en cl que ofrcrco voter o que de wro modo estoy autorizado por Icy pars votq
ell cste precinto, (11) cra residents de esle prec into cuando Ic di al regisl rador do vonlnics la inlorlike i6n perteneciendo a Ili direccibn residencia1, (C) no di informocii n falsa premed itadamente pars asegurar mi registro on un precinti
en el cual no resido. y (D) votare Solanlentc una vez cn la clecei6n.
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*VOTER'S SIMILAR NAME AFFIDAVIT: It' it is deterlishled that the moms oil (he form of identification provided under § 63.0101 is substantially similar per 4 63.001(c), by initialing the square Inhofe(
"Similar Name Affidavit,•' i swear or affirm I not the person on the list of registered voters or the person on the voter registration certificate, and I not one and the saine as the person named on the identification provided;
"DLC'LARACION 1URADA DF NOXIIIRG SIMILAR DGI. VOIANii.: Si se detcnnina que el nonsbre oil el formulario de identificaci6li previsto en § 03.0101 es subsianciabncine similar previsto en §63.001(c), al colocar mis iniciales ej
el cuadro maresdo "Aceptar Decia racidn 1urada", juro o alirino (like soy la persona en la lists de votanles rceistrados o la persona ell cl ccrliticado de iegisno do volanics, y yo soy uno y el mismo conic, la persona nombrada on la identirklicidj
proporcionada. i
For use in Primary Elecdou - A person commits it criminal offense if the person kn mhig;ly votes in a primary election or participates in it convention of another party during the some voting year.
Para Uso en la Flecci6n illimaria - Una persona c51ii culpable de uno oicnr,l criminal si ild persona vota con conocinlicnto ell tins cleccitin primarin o p;oticipa con conocimicnio cn una convencion do otro partido politico dumnte
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*AFFIDAVIT FOR VOTER NOT ON LIST: fly initialing the square labeled "Affidavit for Voter Not sal List", 1 strear or affirm that 1 (A) mu a resident of the precinct in which I am offering to vote or nm otherwise entitled
h • law to vote i that r • tic 13 Iv,s e o e o' v •i n i precinct, n resident of the n•ecinci m haxh •m to r • • a 'o t o r t offering vt lc .tt the time the iratbrm it t n tit residence address, was as provided to the voter registrar, ar C di not , O le tit 1 i and tr d t provide' P i g ,( )
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false information n to s • • e • • is io ' i ' e ' tl e a r a tun registration u m a precinct m 7 loth 1 do not reside,, I) •m s election.
R ! and (1 ) . r altag only mtcc in the cicc r n.
"J URANIFNTO DF VOIANTE: Al finuai con mis iniciales el cuadio mai eado-Acepto Jurantenio", yo deciaro o atinnu que (A) soy residente del prccinto en el que ofrezco voter o que de otro ntocio estoy autorizado por ley pars voter
en estc prccinto, (11) era residents de este prccinto cuando le di al rel istrador do t onawes la infonnaci6tl pertcneciendo a nli direccitin residenciat, (C) no di infonuaci6n filsa premediiadaniente Para asegurar ini registro en till prccinto
en Cl coal no resido, y (D) votarc solamente una vez en la cleccitin. ,
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U I 2 NAME AFFIDAVIT: l it is determined t r.0 the name t th • a i t tit or t form of identification provided under a..ON)1 is sc st: '•all • s' per ' 63.U01 c h ' initialing labeled' } t 3 C tU, lnu. ) . rmdtir p � O, ) titan{ }, tUc square
"Similar'Same Atlidavit," i swear or affirm 1 am the person on the list of registered voters or the person on the voter registration ccrtilicale, and 1 ant one paid the same as the person named on the identification provided. 1
"DFC•LARAC16N JURADA DF N0411)RF SiNULAR DEL VOTAN"YE: Si se delennina que ei mmnbre en el Ramndario tic identilicacitin previstu en ; 63.0101 es snUraancialnlcme similar previsto en §61001(c), al colucar ntis iniciales en'
el cuadro m:an ado "Aceptar Declaration Joiada",.}tiro o afinno que soy la persona ell !a lists tic votantes registrados o la persona en cl ceriiticado do r",istro oe voiaanies, y yo soy into y el misino canto la persona nonibradat en la idenlificacion
ptnpotciunada.
For use in Primary Election - A person coattails a criminal offense if the person knowingly votes in it primary election or participates in a convention of another party during the same voting year.
Nara (iso en la Bleecitin Primauia - Una persona est5 culpable do unit ofenso criminal si till persona uttit con conoeimiento en unit eleccitin primnriu o parliripa con conocinliento ea unit convencitin de o(ro partido politico dun, nte
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*APFIDA�'I'I' IY)R VO'1'I:R NOT ON LISP: By initialing (he square labeled "Affidocif for Voter No(on List," 1 swear or affirm that I (A) au it resident of the precinct in which I ant offering to vote or lint otherwise eattilletl
by law to vote in that precinct, (B) was a resident or the precinct in which 1 uul offering to vote at the (fine the information on my residence address was last provided to the voter registrar, (C) did not deliberately provide
false fit forma tion to secure registration in a precinct in nhich ( do not reside, and (D) :rot voffng only once in the election.
"JIJRA' IFN'1'0 DF VMAWF: Al firmar con mis iniciales el cuadro marcado "Acepto .luramento-, yo declaro o afirow que (A) soy residcnte del prccinto en el title of-mo voter o que de otro modo estoy autorirntlo por ley pars voter
en este prccinto, (B) era residcnte de Isle prccinto cu;mdu le di al iegistrador do vowntes la inRxnlad6n perteneciendo it mi direcci(m residencial, (C) no di infbrmacitin Ihlsa premeditadamcnte pant asegurar mi registro en fin prccinto
cn el cued no resido, y (D) vowir solamenie uua vez co la elceci6n.
*VOTER'S SIMILAR NAME AFFIDAVIT: If it is determined that (he name fin file form of identification provided under § 63.0101 is substantially similar per § 63.001(c), by Initialing the square labeled
Voter's "Similar Name Affidavit," I swear or affirm 1 ant the person on file list of registered voters or the person on file voter registration certificate, and I fill line and the sane as the person named on the identification provided.
lnitel V ',DECLARACION JURADA DE, NOMBRE SINMILAR DEi. VOTANTE: Si se de!enniuu) floc el aondpre ea of I'mim ludo de idcntificaci6li aevisto en 63.0101 es substancialniente similar re into en §63.001 c al coloear mis iniciales en
ls
(hlicialcs del Volatile) I § P " � � t ).
ei cuadro marcitdo "Aceplar Deciaracik Amidii". jaro o al'n-mo que soy fa pet Bona en fa lists de Votarues re$is!ra,los o la persona en el cerlificado de registro do volanles, y yo Soy ono y el mismo cones la persona nombrada en )a identificaei6n
proporcfonada.
tianllnr\mac .t(I(An,it 1'or Voter
vadu,u Not fin t.bt" For use fit Primary ElccIion -A person commits a criminal offense il'tile person kit(min gly votes fit it )rini:try election or pitrfici pates fn a convention of another tars y during the same votin ear.
Urdnrnai,iu.Iurada Occlurucbin.larm(n J 1 i b i 1 i I J 6 gy'
it, Noinnre Similar ( Al Votank Pal-il t)so ell In FACC6611 Fliminia - Unit persona emii culpable de tlna ofen5a CI imil l! Si !it! persona %wil Con cultociltneldn ell [ilia ClecciOn primaria o parficlpa coil conocitniento en unit convention de otro partido politico durante
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(full of EY-WOJ•)U. --a MR pill, y�x01 I�OI,.Lt''I�(I�IINO:� ssa.tpp�; titauN alpa!aul (eaao,i snll)n y,t:q sill uo ann►luoi •.ti.tt:ssaaau oar. sou!! 1uulslsstr .I310A lnnu!1!ppa,{I) )uulslssVXVOA
• Voter Assistant (if additional voter assistant titres are necessary, continue on the back of this form) Include ,Name, Address
Lint: # Asistente de Votantes (si lincas adicionalcs son necesarias para asistente de volantes, continue en 0 reverso de este fornlulario)
incluya Notnbre. Dircceitin
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Location (Sitio)
County Precinct No.
Nuro. de Precincto
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5
Date of Election (I echo de clecci(in} Type of Election (Tipo tie elecci6n)
C'. t_t a o -x �; C ► T\I�- \j rlt ► # SOc t A Z-
VUID Poll List (Lists de Votantes) ., ..,, ,\, 1:_ .J 1 v ,•,•,,��
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COMBINATION FORM and
1 ESES Fnme 7X-COM-0.7 t81//8) � _
nr 213Oe. by A.113 U06.63
6of Stole
B.Kfi]001,8]q:t1,G]C8'J.8:4081.87 CLW,lU tl06.e31189,
Early Voting Roster for Early Voting 800181, 12t t,F4M.0t" 45031.87!Y118i ON T.— Fdwku,wd. rw
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WB id180.Sf18,J1821m onlannp Ydo
(Check ifApplicable) Marear si Corresponde) If a voter Is unable to sign his/her name, an election official shall place the voter's name on
the signature roster and make a notation as to the reason the voter is unable to sign.
.. sJ Si aibiin votante no puede riniiitr su nonlbre, Wi oficial electoral appnnmr5 cl nombre del votanf a en cl
u ® a r registro de firmas y hart( una anotacion indicattdo la cause por la coal el votante no pudo finnar.
as
fn 2 M O M o
Signature (Firma)
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Sworn to aand'subscribed bcfoic me this t
day or _)) �% f�. t _-_ — 20
Early toting Clerk __ _ •_�'�i,li�i,.11t,/.ky.l�.t,..