"State of Alabama, County of ______________ I do solemnly swear (or affirm) that I am a registered voter in the precinct in which I am seeking to vote and that I am eligible to vote in this election.
________________ |
Signature or Mark |
________________ |
Printed Name of Voter |
________________ |
Printed Residence Address of Voter |
________________ |
City State Zip Code |
________________ |
Date of Birth" |
Ala. Code § 17-10-2 (1975)