Minnesota Administrative Rules
Agency 133 - Secretary of State
Chapter 8200 - VOTER REGISTRATION
FORMS
Part 8200.9939 - FORM OF OATH, SPECIFIED BY PART 8200.5100
Use this form only if you are registering to vote with a voucher as your proof of residence.
I, _______________________ (Name of Voucher) swear or affirm that (Check one):
() I am pre-registered to vote in this precinct
Voter ID ____________________
(to be completed by the election judge)
() I registered in this precinct today and did not have another person vouch for me
() I am an employee of a residential facility
_________________
(Name of residential facility)
Residential Address of Voucher or Address of Residential Facility
_____________________________________________________________
Street Address City
Telephone number __________________
E-mail address (optional) __________________
I personally know that _______________________________________________
(Name of person registering)
is a resident of this precinct.
_____________________
Signature of Voucher
Election Judge Official Use Only:
Subscribed and sworn to before me
__/__/____ ___________________________
Date Signature of Election Judge
The above oath shall be attached to the voter registration card and retained for at least 22 months.
Statutory Authority: MS s 201.022; 201.061; 201.221; 203B.09