Current through Chapter 269 of the 2016 Legislative Session
STATE OF FLORIDA
COUNTY OF ____
I do solemnly swear (or affirm) that my name is ____; that my date of birth is ____; that I am registered and qualified to vote in ____ County, Florida; that I am registered in the ____ Party; that I am a qualified voter of the county; and that I have not voted in this election. I understand that if I 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.
(Signature of Voter)
(Current Residence Address)
(Current Mailing Address)
(City, State, Zip Code)
(Driver's License Number or Last Four Digits of Social Security Number)
Sworn to and subscribed before me this ____ day of _______, (year).
(Election Official)
Precinct # ____ Ballot Style/Party Issued: ____