CHALLENGES TO VOTER REGISTRATION, SPECIFIED BY PART 8200.7100

To the Auditor of _ County County Courthouse _ (County Seat), Minnesota I, __________________________ (Name of person making challenge), am a registered voter in ______________________ County, Minnesota. I reside at ________________________ (Street or Route No.) _______________________ (City or Township). I challenge the registration of ______________________ (Name of challenged voter) whose registration lists his or her residence as __________________________ (Street or Route No.) ________________________ (City or Township). The grounds for my challenge are based on the following facts and circumstances: _ _ _ (attach additional sheets of signed statement, including supporting documents, affidavits, or other evidence, if necessary). I swear or affirm that this challenge is based on my personal knowledge, and that I have exercised due diligence to personally verify the facts and circumstances establishing the basis for the challenge. __/__/__ _ (Date) (Signature of Challenger)