Early Voters Roster 5-1-2023*AFFIDAVIT FOR VOTER NOT ON LIST: By initialing the square labeled "Affidavit for Voter Not on List," I swear or affirm that 1(A) am it resident of the precinct in which I am offering to vote or am otherwise entitled
`I I IJ 3u!,1 n ,41J1r_l by law to vote in that precinct, (B) was a resident of the precinct in which 1 am offering to vote at the time the information on my residence address was last provided to the voter registrar, C did not deliberately provide
false information to secure registration bl a precinct in which 1 do not reside, and (D) am voting only once in the election.
0 --- to Sap *JURAMENTO DE VOTANTE: AI finnar con nlis iniciales el cuadro marcudo "Acepto Juranlento", yo declaro o alirmu que (A) soy residente del prccinto en el que ofrezco votar o quC de otro nlodo estoy autorizado por ley pars votar
Y. (i en este precinco, (B) cra residente de este precinto cuando le di al registrador de votaries in infonnacion pertenecieudu a nli dirccciun residencial, (C) no di infornlacion falsa prenleditadanlenle Para asegurar mi registro en all prccinto
en! atu e.lgloq p;rq!.lasgns pue of utoAtS en el cual no resido, y (D) volard solamente una vez en la cleceion.
*VOTER'S SIMILAR NAME AFFIDAVIT: If it is determined that the name on the form of identification provided under § 63.0101 is substantially similar per § 63.001(c), by initialing the square labeled
�t V Voter's "Similar Name Affidavit," I swear or affirm 1 am the person on the list of registered voters or the person on the voter registration certificate, and 1 am one and the same us the person named on the identification provided.
initials *DECLARACi6N JURADA DE NOMBRE SIMILAR DEL VOTANTE: Si se determina L uC Clnombre en el fonnulario Lie idemificaciOn re into en • 63.0101 es substancialmenie similar previsto en §63.001(e), al colocar mis inichiles en
� (InicialcsLlcl Votan,e) 1 I "' � §
'�' 1, r el CLUidro murcado "Aceptar Dcelaracik Jurada", juro o afinno que soy la persona en in lists de votantes regislrados o la persona en el ceriificado de registro de vomntes, Y yo soy ono y el mismo como In persona nombl da en In ideniifieaci8n
�uo!�, a 3upan xun ,pool m + proporeionuda.
I 1 I \ tiimilar Snnu• Allidmil For \'uler
naidu u" Ynd on IJ}I• For use in Primary Election - A pet -son commits a criminal offense if the person knowingly votes in a primary election o► participates in a convention of another arty during the same voting year.
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/ ri rmP 1 n;tP(1 a!}pl(ll de \nmbrr �iuular del Valanlc Paril U50 CO to EIL'CCI011 PI•imarlil - Ulla perS011a es15 CuipablC dC ails OfCiltia criminal tip tal persona vola Coll collochrientll ell urn cleccltln primana o particlpa COIL C011061niC1n0 ell unit COnye11Ci6n do olro purlido politico durance
1J.m• el mismo aiio do votaclk.
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*AFFIDAVIT FOR VOTER NOT ON LIST. By initialing the square labeled "Affidavit for Voter Not on List," i swear or affirm that I (A) am a resident of the precinct in which 1 am offering to vote or ant otherwise entitled
by law to vote in that precinct, (B) was a resident of the precinct in which 1 am offering to vote at the time the information on my residence address was last provided to the voter registrar, (C) did not deliberately provide;
false information to secure registration in a precinct in which 1 do not reside, and (D) am voting only once in the election.
*JURAMENTO DE VOTANTE: AI firmar con ntis iniciales cl cuadro marcado "Acepto Jurtunento", yo declaro o atinno clue (A) soy residente del precinto en el que ofrezco votar o que de otro modo estoy autorizado por ley pars votary
en este precinto, (B) cra residente de este precinto cuaddo le di al regislrador de votantes la infonnaci6n petteneciendo a n,i direcci611 residencial, (C) no di inl'ormacion falsa premeditadamente para asegurar lni regisno en on precinto
en el cual no resido, y (D) votard solamente una vez en In elecci6n.
*VOTER'S SIMILAR NAME AFFIDAVIT: if it is determined that the name on the form of identification provided under § 63.0101 is substantially similar per § 63.001(c), by initialing the square labeled
"Similar Name Affidavit," i swear or affirm 1 am the person on the list of registered voters or the person oilthe voter regish•ation certificate, and 1 am one and the same as the person named on the identification provided.
"DECLARACiON JURADA DE NOMBRE SiMiLAR DEL VOTANTE: Si se determine que el nontbre en cl fonnulario de identificacitin previsto en § 63.0101 es substancialn,ente similar previsto en §63.001(c), ai colocar mis iniciales en
el cuadro marcado "Aceptar Declaraci6n Jurada", juro o af,nuo que soy la persona en la lists de votantes registrtdos o la persona en el cerlificado de registro de votantes, y yo soy uno y el ntisnto como la persona nombrada en la identificacitin
proporcionada.
For use In Primary Election -A person commits a criminal offense if the person knowingly votes in a primary election or participates fu a convention of another party during the same voting year.
Pant llso en In Elecci6n Prin,arin - Una persona esti culpable de una ofensa criminal si lal persona vtoa con conocin,iento en una elecei6n prinrtria o participa con conocimiento en una convencion de otro partido politico durante
el misn,o ano de vomc:i6n.
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Voter Assistant (if additional voter assistant lines are necessary, continue on the back of this form) include Name, Address
Ane # As,stente tic Volmltes (si linens adicionales son necesarias pars asistente de volautes, comini,e en el reverso de este formulario)
Incluya Nombre, Direcci8n
Location (Sitio)
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Num. do Precinctc
Date of El7ti n (Fecha de eleccion)
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COMBINATION FORM and Prescribedtib).secr.0011, 3002 63,0035.2t n1;2,1a
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Sections (,3.no1, fiaouil, 63.nu2, a3.un;, 63.004, ea.nor,, 63.00'>, 63.011,
Early Voting Roster for Early Voting 03.011,64.032.81.002.85.031,87.121 and 102.0II4'e.as,:,cctioll Code
(Check if Applicable) (Marear si C'orresponde) If a voter is unable to sign his/her name, fill election official shall place the voter's name fill
the signature roster and make a notatioll as to the reason the voter is unable to sign.
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Si algim votante no puede firmar su nombre, un oficial electoral a xnuani el nombre (lei votame en el
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*AFFIDAVIT FOR VOTER NOT ON LiST. By initialing the square labeled "Affidavit for Voter Not on List," I swear o affirm that I (A) am a resident of the precinct in which I am offering to vote or am otherwise entitled
by law to vote in that precinct, (B) was a resident of the precinct In which I am offering to vote at the time the information on my residence address was last provided to the voter registrar, (C) did not deliberately provide
false Information to secure registration In a precinct in which I do not reside, and (D) am voting only once in the election.
*JURAMENTO DE VOTANTE: Al finnar con mis iniciales el cundro mareado "Acepto Juranlento", yo declaro o aiimlo que (A) soy residento del precinto en el que ofrezco votar o que de otro modo estoy autorizado por ley para votar
cn estc precinto, (B) era residente de este precinto cuando le di al registrador de votantes la infotmacicin perteneciendo a mi direecion residencial, (C) no di inforniacibn f rlsa prenleditadamente para asegurar mi registro en un precinto
en el cual no reside, y (D) votaro soiamente una vez on la cleccion.
*VOTER'S SIMILAR NAME AFFIDAVIT: If it is determined that the name on the form of identification provided under § 63.0101 is substantially similar per § 63.001(c), by Initialing the square labeled
"Similar Name Affidavit," i swear or affirm I am the person on the list of registered voters or the person on the voter registration certificate, and i am one and the same as the person Danced on the identification provided.
*D17CLARAC16N JURADA DE NOMBRE SIMILAR DELVOTANTE: Si se detemlina que el nombre on el fomtulario lie identilicaoion previsto en § 63.0101 es substancialmente similar previsto en §63.00l(c), al colocar mis iniciales en
el cuadin mareado "Aceptar Declameion Jurada", juro o afirmo que soy la persona on In lista de votantes registrados o la persona on cl certificado do registro de votantes, y yo soy uno y el iiiisnro conlo la persona nombrada en la identificacion
proporcionada.
For use in Primary Election -A person commits it criminal offense if the person knowingly votes in a primary election or participates in a convention of another party during the same voting year.
Pam Uso on la Eleccion Primaria - Una persona estd culpable de una ofensa criminal s[ (al persona vola con conocimiento on una cleccion primaria o participa con conocimiento en una convention de otro partido politico durttnte
el mismo ailo de votacion.
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Ialse information to secure registration in a precinct in which 1 do not reside, and (D) am voting only once in the election.
*JURAMENTO DE VOTANTE: Al flm,ar con this iniciales el cuadro marcado "Acepto Juraniento", yo deciaro o afirn,o que (A) soy residents del precinto en el que ofrezco votar o que sic otro ntodo estoy autorizado per ley Para voter
en este precinto, (B) cra residence de este precinto cuando le di al registrador de votantes la infotmacitin perieucciendo a nii direcci6n residencial, (C) no di informaciim falsa prentediuldaniente pant asegurar nii registro en tilt precinto
en el cual no resido, y (D) votard solamente una vez en la elecci611.
*VOTER'S SiMiLAR NAME AFFIDAVIT: If it is determined that the name on (lie form of identification provided under § 63.0101 is substantially similar per § 63.001(c), by initialing the square labeled
"Shullar Nanie Atlfdavil," 1 swear or atiirm lam the person on the list of registered voters or the person on (lie voter registration certificate, and 1 am one and the same as the person name([ on the identification provided.
*DECLARACION JURADA DE NOMBRL' SIMILAR DEL VOTANTE: Si se determina que el nonibre en el formulario ale identilicaci6n previsto en § 63.0101 es substancialmcnic similar previsto en §63.001(e), al colocar niis iniciales en
cl cuadro mareado "Aceptar Declaraci6n Juradq",juro o afirnio que soy la persona en In lista de vo(antes registrador o la persona en el certificado de registro de votantes, y yo soy uno y el misnio conio la persona nombracla en la identificaci6n
proporciOlUtda.
For use fit Primary Election -A person commits a criminal offense if the person knowingly votes in a primary election or participates in a convention of another party during the same voting year.
Para Uso en la Eiecci6n Priritaria - Unit persona cslti culpable de una ofensa criminal si tal persona vota con conociniiento en una elecci6n primaria o participa con conociniiento en una cenveuci6n tic otro partido politico durante
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