Fla. Stat. § 101.6921
Note: Please Read Instructions Carefully Before Marking Ballot and Completing Voter's Certificate.
VOTER'S CERTIFICATE
I,, do solemnly swear or affirm that I am a qualified and registered voter of County, Florida, and that I have not and will not vote more than one ballot in this election. I understand that if I commit or attempt to commit any fraud in connection with voting, vote a fraudulent ballot, or vote more than once in an election, I can be convicted of a felony of the third degree and fined up to $5,000 and/or imprisoned for up to 5 years. I also understand that failure to sign this certificate will invalidate my ballot. I understand that unless I meet one of the exemptions below, I must provide a copy of a current and valid identification as provided in the instruction sheet to the supervisor of elections in order for my ballot to count.
I further certify that I am exempt from the requirements to furnish a copy of a current and valid identification with my ballot because of one or more of the following (check all that apply):
[] I am 65 years of age or older.
[] I have a permanent or temporary physical disability.
[] I am a member of a uniformed service on active duty who, by reason of such active duty, will be absent from the county on election day.
[] I am a member of the Merchant Marine who, by reason of service in the Merchant Marine, will be absent from the county on election day.
[] I am the spouse or dependent of a member of the uniformed service or Merchant Marine who, by reason of the active duty or service of the member, will be absent from the county on election day.
[] I am currently residing outside the United States.
(Date) Voter's Signature
Fla. Stat. § 101.6921