VOTER'S CERTIFICATE I hereby certify that I am qualified to vote at the (primary or election) held on __________________, that I have not and will not vote elsewhere in this (primary or election) in my own name or in any other name, and that I am a citizen of the United States and am not currently serving a sentence for a felony conviction. I understand that making a false statement on this certificate is a felony under Code Section 21-2-562.
Signature __________________ | |
Current residence address of elector: | |
__________________ | |
Elector's date of birth: __________________ | |
Name or initials of poll officer receiving voter's certificate: __________________ | |
In case of physical disability or illiteracy, fill out the following: | |
Reason for assistance (Check appropriate square): | |
( ) Elector is unable to read the English language. | |
( ) Elector requires assistance due to physical disability. | |
__________________ | |
Signature of poll officer | |
Number of stub of ballot or number of admission to voting machine: __________________ |
OCGA § 21-2-402