Early Voters Roster 4-27-2023l
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*AFFIDAVIT FOR VOTER NOT ON 1dST: By initialing the square labeled "Affidavit for Voter Not on List;' I swear or affirm that I (A) am :I resident ofthe precinct in which I am offering to vote or am otherwise entitled
rovid •: • t thevoterregistrar, C 'd notdeliberately� v • • ad h• •ss was last nvvitlul o tl dl o Uy law to otl in that precinct, (13) was a resident of the precinct Gl which I um offering to vote at the time the information of my residence address . l ( ) p
false information to secure registration in a precinct fu which I do not reside, and (D) am voting only once ill the election.
*JGRAMENTO DE VOTANTE: AI tirmar con mis iniciales el cuadro marcado "Acepto Jurmnento", yo declaro o aftrmo quc (A) soy resideute del precinto en el quc otiezco voter o gate de otro nlodo estoy autorizado por ley pars voter
en este precinto, (B) era residenle de este precinto cuando le di al registrador de votantes In infornmcidn perteneciendu it nli direccitin resideucial, (C) no di infornutci6n falsa prenleditadamente para asegurar mi registro en on precintod
en el coal no resido, y (D) votary, solamcnte mia vez en (a clecci6n.
*VOTER'S SIMILAR NAME AFFIDAVIT: If it is determined that tile name on the form of identification provided under § 63.0101 is Substantially similar per § 63.001(c), by initialing the square labeled
to N �-) 3 7, Voter's "Similar Name Affidavit," I swear or aflirnr I :nn the person oil the list of registered voters or (lie person oil tile voter registration certificate, .111411 ant one and the Sallie as the person named on the identification provided,
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Initials del
del Vor,uttc) se ermq ue el nonibre en el fornudario de identificecp' § I *DECLARACION Jt1RADA DE NO�IBRE SINIiLAR DEL. VOTANTL: Si detine i6n evisto en 63.0101 es substancialnrente similar lrevisto en § 63.001( c) , al colocar mis iniciales en
k). It , el cuadro marcado "Aceptar Declaraci6n Jurada", Juro o afirnio quc soy la persona en la lista de vote nes registrtdos o la persona en,el certifir,tdo do registro de votantes, y yo soy into y el misnx) comp la persona nombrada en la identificacion'
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Amdas'u* Noe an I.,st" For use in Primary Lleclion - A person commits a criminal offense if the person knowingly votes in a n imm• election or participates in a convention of another )art during the same voting year.
Dedaracldu Jaruda Dednraddl, Jurada Y I' 1 6 Y primary l Y g by
�• -- , ,. _ :.. .1. Noml,re Siwa,, (let Votautc• Para I No en la Llecci6n Primal is • Una persona est:i culpable de unit olcusa criminal A tal persona vota Coll Conocioliento en una elecci6n prinutria o participa con conociniiento en una convenci6n de otro partido politico durmlte '
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FOR VO'1'I;li NOT ON LIST: fly initialing the square labeled "Affidavit for Voter Not on List," ! swear or affirm that I (A) am a resident of the precinct in which 1 am offering to vote orarm othervr•ise entitled
by law to vote in that precinct, (li) was a resident of the precinct i1t which [ um offering to vote at fhc time the information on my residence address was lust provided to the voter registrar, (C) did not deliberately provide
false iuforntatinu to secure registration in it precinct fit which 1 dot not reside, and (U) am voting only once in the election.
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• o c de ro o c • a riz: ( wr I urn voter ' c • o'�czco voter mI ot mod sto uto td) e l \�[' 1'C( i V(' ti ''• c • r •� > � � c+ � el e :in en t ill, ll JL it . L\ ) D[ ) CA. A ) a • coil +' • 'nic'• Ics el c la llo tla (+ to " 1 tr : • A ac rind 1 tc d )1 c [o 'I L. l un) l I Is l la + , c A )tc + ; 1 rl o •dtrn l l 1 cc Jl r l 1 c uu' o dl:cl Ir o. Y
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en este precintu, (l3) era residents tie este precintu cuan(lo !c di at regisU:ulor de voCultes la inl'ornmcior, pertalccicn(lo :1 mi (lirccciim resi(tencial, (C) nu di inforroaci(Sn lalsa pren+editadamente para asegurar mi registro en lul prccinto j
cn el coal no resido, y (D) votari solamente una vcz en la elccciein.
*Vq'1'1?R`S SIi11LAR NA\1F. AFFii))\1'1'P: If it is dcterutiucll that the name on the form of identification provided under § 63.O1O1 is substantially similar per § 63.001(c), by initialing the square Iabcicd
"Similar Name Affidavit," 1 swear or affirm 1 :un the person on the list of registered voters of the person oil the voter registration certificate, and ! am one and the same as the person named mt the Identification provided. '
"DF.('LAlir\C[nN JUItADA DE N0411312L' SIiv1ILAR UL•:C. VO'1'ANTC•.: Si se <leternliva quc el nomb!•e en el formulario c!c identi(ic:lci(in prccinto en § 63.0I01 es subst:lnciahnenle sillti!ar previstu en §63.001(c), al coloear min iniciaies en
el cunllru marcado "r\ccptar Declaration Jurada", juro o alirmo quc soy is persona en la lisla de vutantex registrados it la persona en el cerli(icaeio de registro do votantes, y yu soy ono y el mismo cumo !a persona nombmda en la iclentificaci(in
proporcioua(la.
For use fit Primary Election - A person commits a criminal offcusc if the person knowingly votes in a primary election or participates in it convention of another party during the same voting year,
Para Uso en la lilecci6n Prinrlria -Una persona eshi culpable tic Unx ntensa crin)inal si ad persona vole con conocimiento e❑ una eicecicn primaria o parlicipa con conocimiento en una convenci(in de otro partitlo politico duraate
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Voter Assistant (if additional voter assistant lines are necessary, continue on the hack of this form) include `ante, All (Iress COMBINATION FORM and
Line # Asistenle de Votantes (si lineas adicioaales Sou 1weesarias pure asistealc do vouuttes, coutili le en cl reverso lie este li/rmulario) 1 �, Early Voting
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ESdS Form TXCOM-03 (01118)
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Location (Sitio) I Date of Election (Fecl)a de elecci6n)
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If it 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.
Si alglin votante no puede furmar sit nombre, un oficial electoral a )unlarA el nombre (le] votante en el
registro de firimas y harh una anotaci6n indicando la causa por Ia cual el volatile no pudo ftlntar.
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