Kan. Stat. § 25-1122d
Affirmation of an Elector of the County of ______________ and State of Kansas Desiring to Vote an Advance Voting Ballot
State of ______________, County of ______________, ss:
I,______________________________________________
(Please print name)
do solemnly affirm under penalty of perjury that I am a qualified elector of the ______ precinct of the _______ ward, residing at number ________ on ____________ street, city of _________, or in the township of __________, county of __________, and state of Kansas. My date of birth is _______ (month/day/year).
I understand that a current and valid Kansas driver's license number or Kansas nondriver's identification card number must be provided in order to receive a ballot. If I do not have a current and valid Kansas driver's license number or Kansas nondriver's identification card number, I must provide one of the following forms of identification with this application in order to receive a ballot:
A copy of any one of the following types of photographic identification: A driver's license issued by Kansas or by another state or district of the United States, a state identification card issued by Kansas or by another state or district of the United States, a concealed carry of handgun license issued by Kansas or a concealed carry of handgun or weapon license issued by another state or district of the United States, a United States passport, an employee badge or identification document issued by a municipal, county, state, or federal government office or agency, a military identification document issued by the United States, a student identification card issued by an accredited post secondary institution of education in the state of Kansas, or a public assistance identification card issued by a municipal, county, state, or federal government office or agency.
I am entitled to vote an advance voting ballot and I have not voted and will not otherwise vote at the election to be held on ____________ (date). My political party is __________ (to be filled in only when requesting primary election ballots). I desire my ballots to be sent to the following address:
___________________________________
___________________________________
Signature of voter.
Note: False statement on this affirmation is a severity level 9, nonperson felony.
Affirmation of an Elector of the County of ______________ and State of Kansas Desiring to Vote an Advance Voting Ballot
State of ______________, County of ______________, ss:
I, ____________________________________________
(Please print name)
do solemnly affirm under penalty of perjury that I am a qualified elector of the _______ precinct of the _______ ward, residing at number ________ on ____________ street, city of _________, or in the township of __________, county of _______, and state of Kansas. My date of birth is __________ (month/day/year).
I am entitled to vote an advance voting ballot and I have not voted and will not otherwise vote at the election to be held on ____________ (date). My political party is ___________ (to be filled in only when requesting primary election ballots).
__________________________________
__________________________________
Signature of voter.
Note: False statement on this affirmation is a severity level 9, nonperson felony.
K.S.A. 25-1122d
Revisor's Note:
Section was also amended by L. 2004, ch. 25, § 5, but that version was repealed by L. 2004, ch. 93, § 13.