I do solemnly swear that I am the person identified above and the information provided is correct. I understand that my vote will not be counted unless: | |
(1) (a) I return to this polling place today between 6:00 a.m. and 7:00 p.m. and provide one of the following forms of identification: | |
a. Nonexpired Missouri driver's license; | |
b. Nonexpired or nonexpiring Missouri nondriver's license; | |
c. A document that satisfies all of the following requirements: | |
(i) The document contains my name, in substantially the same form as the most recent signature on my voter registration record; | |
(ii) The document contains my photograph; | |
(iii) The document contains an expiration date and is not expired, or if expired, the document expired after the date of the most recent general election; and | |
(iv) The document was issued by the United States or the state of Missouri; or | |
d. Identification containing my photograph issued to me by the Missouri National Guard, the United States Armed Forces, including Space Force, or the United States Department of Veteran Affairs as a member or former member of the Missouri National Guard or the United States Armed Forces that is not expired or does not have an expiration date; or | |
(b) The election authority verifies my identity by comparing my signature on this envelope to the signature on file with the election authority and determines that I was eligible to cast a ballot at this polling place; and | |
(2) This provisional ballot otherwise qualifies to be counted under the laws of the State of Missouri. | |
__________________ | ____________________ |
Signature of Voter | Date |
__________________ | ____________________ |
Signature of Election Officials |
Once voted, the provisional ballot shall be sealed in the provisional ballot envelope and placed in a separate secured container by the election judge.
Any individual seeking one of the above documents in order to obtain a form of personal photo identification described in subsection 1 of this section for voting may request the secretary of state to facilitate the acquisition of such documents. The secretary of state shall pay any fee or fees charged by another state or its agencies, or any court of competent jurisdiction in this state or any other state, or the federal government or its agencies, in order to obtain any of the above documents from such state or the federal government.
VOTER'S IDENTIFICATION CERTIFICATE | |
Warning: It is against the law for anyone to vote, or attempt to vote, without having a lawful right to vote. | |
PRECINCT | |
WARD OR TOWNSHIP ______ | |
GENERAL (SPECIAL, PRIMARY) ELECTION | |
Held ______, 20______ | |
Date | |
I hereby certify that I am qualified to vote at this election by signing my name and verifying my address by signing my initials next to my address. |
§ 115.427, RSMo
Effective 6-14-06