Storage and Maintenance

Storage and Maintenance. The Circuit Clerk shall be the custodian of the EPBs acquired by the county and shall be charged with the proper storage, maintenance and repair of the county’s EPBs. Source: Miss. Code Ann. § 23-15-169.5. Exhibit A Part 10: EXHIBIT B Format: 5x8 White Envelope for Affidavit Voters 5x8 Yellow Envelope for Voter ID Affidavit Voters Side 1: Plain (non-flap) Side of the Envelope SEMS # AFFIDAVIT BALLOT 1. VOTER INFORMATION (to be completed by voter) X Printed Name of Voter Maiden Name, if applicable Date of Birth *MS Driver’s License # Daytime Phone # New (Current Street Address - NO P.O. Box) City & Zip Code Old (Previous Street Address - NO P.O. Box) City & Zip Code Current Mailing Address City & Zip Code Did you recently register to vote in this county? Yes No * If you do not have a Mississippi Driver’s License, then provide the last 4 digits of your Social Security number. AFFIDAVIT OF VOTER (Check only ONE box below) This day, I personally appeared before the undersigned manager of the election and make the following affidavit, under penalty of law: [ ] I am not registered to vote because I have been illegally denied registration; OR, I am eligible to vote in this election; I am a resident of this precinct and lawfully registered to vote in this county at least 30 days prior to this date, and: [ ] I have moved recently from the old street address (provided above) to the new address (provided above); OR, [ ] I have not moved recently, but my name is not on the pollbook; OR, [ ] I did not present acceptable photo ID; OR, [ ] I have a religious objection to being photographed; OR, [ ] I do not otherwise qualify under state or federal law to cast a regular election day ballot. X Signature of Voter Date X Signature of Poll Manager (Poll Manager: Be sure to complete Poll Manager Information on other side of this envelope.) NOTICE TO VOTER: • Be sure you have read and completed all areas printed above. • Be sure you have signed this affidavit envelope. • You are entitled to receive written information on how to learn if your affidavit ballot was counted and, if it was not counted, the reason it was not counted. [Side 2: Flap Side of the Envelope] 2. POLL MANAGER (Must sign on the other side of envelope) Election: [ ] Primary [ ] General [ ] Special ______________________________, 20 County of (Month, Date) Reason for Affidavit Ballot [ ] Voter’s name not on pollbook [ ] Voter did not present ID [ ] Voter’s name on inactive list Date of Election: Ballot issued from: (Name of Precinct) Comments: 3. FOR ELECTION COMMISSION OR PARTY COMMITTEE USE ONLY Registered in Precinct: (Name of Precinct) Voted in Precinct: (Name of Precinct) Mark all that apply: [ ] Not registered and no evidence of registration [ ] Registered but name not on pollbook [ ] Registered too late [ ] Moved within county/municipality [ ] Moved outside county/municipality [ ] Inactive or purged voter [ ] No acceptable photo ID [ ] Voter presented photo ID within 5 business days after casting ballot. [ ] Voter did not present photo ID within 5 business days after casting ballot. [ ] Voter completed affidavit of religious objection within 5 business days after casting ballot. [ ] Voter did not complete affidavit of religious objection within 5 business days after casting ballot. Final Action Taken on Affidavit Ballot: [ ] ACCEPTED [ ] REJECTED Follow-Up Action Taken: [ ] Address changed/updated in SEMS [ ] Voter returned to active status in SEMS [ ] Information forwarded to county/municipality [ ] Mail-in voter registration sent to voter EXHIBIT C. INSTRUCTIONS FOR VOTERS WHO CAST AFFIDAVIT BALLOTS You have cast an affidavit ballot because: You are not registered to vote because you may have been illegally denied registration; or You are eligible to vote in this election; you are a resident of this precinct and lawfully registered to vote in this county at least 30 days prior to this date, and: o You have moved recently from an old street address, as provided on your affidavit ballot envelope, to a new address, also provided on your affidavit ballot envelope; or o You have not moved recently, but your name is not on the pollbook; or o You did not present photo ID; or o You have a religious objection to being photographed; or o You do not otherwise qualify under state or federal law to cast a regular Election Day ballot. If you cast an affidavit ballot because you did not present photo ID, your affidavit ballot will not be rejected for this reason if you present acceptable photo ID in the Circuit Clerk’s Office within the next five (5) business days. If you do not present acceptable photo ID in the Circuit Clerk’s Office within the next five (5) business days, your affidavit ballot will not be counted. If you cast an affidavit ballot because you did not present photo ID based upon a religious object to being photographed, your affidavit ballot will not be rejected for this reason if you complete an Affidavit of Religious Objection in the Circuit Clerk’s Office within the next five (5) business days. If you do not complete an Affidavit of Religious Objection in the Circuit Clerk’s Office within the next five (5) business days, your affidavit ballot will not be counted. Under federal and state law, you are entitled to discover the disposition of your affidavit ballot. Please contact your party executive committee (in primary elections), your election commission (in general and special elections) or your Circuit Clerk to determine whether your affidavit ballot was counted and, if not, then why. Please do not telephone the contact until ten (10) days from today. CONTACT: TELEPHONE NUMBER: 1-10 Exhibit D MISSISSIPPI MAIL-IN VOTER REGISTRATION APPLICATION Agency Code: • You can use this form to: register to vote in Mississippi or change your name and/or address. • If you are registering for the first time in Mississippi and DO NOT have a Mississippi driver’s license or social security number, you must send with this application a copy of a current and valid photo ID or a copy of a current utility bill, bank statement, government check, paycheck or other government document that shows your name and address in this county. • An application for voter registration must be postmarked or hand delivered to the Circuit Clerk’s Office located in the county of your voting residence no later than 30 days before an election. • You may not register to vote if you have been convicted in a Mississippi state court of any of the following crimes: voter fraud, murder, rape, bribery, theft, arson, obtaining money or goods under false pretense, perjury, forgery, embezzlement, bigamy, armed robbery, extortion, felony bad check, felony shoplifting, larceny, receiving stolen property, robbery, timber larceny, unlawful taking of a motor vehicle, statutory rape, carjacking or larceny under lease or rental agreement. • If you live in an area without house numbers or street names, please include a drawing of your location to enable us to identify your appropriate voting precinct. • Photo ID Required to Vote: You will be required to present an acceptable form of photo identification when you vote at your polling place on Election Day or by absentee ballot in your Circuit Clerk’s Office, unless exempted by law. For more information, go to www.MSVoterID.ms.gov or call (844) 678-6837. Check One: □ New Registration □ Change of Information Are you a citizen of the United States of America? Yes □ No □ Will you be 18 years of age on or before Election Day? Yes □ No □ NOTE: If you checked ‘No’ in response to either of these questions, DO NOT complete this form. Would you like to serve as an Election Day poll worker? Yes □ No □ Name Last Name Maiden Name First Name Middle Name Suffix Physical Home Address (Where you live) Number and Street/Road/Dorm/Apt # City County State: MS Zip Mailing Address (If different from above) Street or Post Office Box City County State: Zip Date of Birth Month Day Year MS Driver’s License Number or Last 4 Digits of your Social Security Number _______________________ or ___ ___ ___ ___ Phone # Cell ( ) Work ( ) Email Previous Registration Name Address City County State: Zip VOTER DECLARATION- Read and Sign I swear/affirm, under penalty of perjury, that: • I am a U.S. citizen. • I will be 18 years of age on or before the next general Election Day. • I am a resident of Mississippi, this county and this city for at least 30 days. • I have not been adjudicated as mentally incompetent. • I have never been convicted of voter fraud or any other disenfranchising crime OR, if convicted, I have had my voting rights restored as required by law. • The address listed above is my legal place of residence. WARNING: Giving false information to register to vote is a felony punishable by a fine of not more than $5,000 or imprisonment for not more than 5 years, or both. Miss. Code Ann. § 23-15-17. X ___________________________________________________ Date: ________________ Signature (or mark) of applicant X If applicant is unable to sign, the person who assisted the applicant Address Date: ________________ Exhibit E 1- Part 10, Exhibit E MISSISSIPPI VOTER REGISTRATION 1. Are you a citizen of the United States Of America? Yes No INSTRUCTIONS 2. Will you be 18 years of age on or before Election Day? Yes No You may use this form to: 3. (Optional) Would you like to serve as Election Day Poll Worker? Yes No > Register to vote. > Change your registration information (i.e., mailing address, name, residence address). If you checked "NO" in response to questions 1 or 2, DO NOT COMPLETE THIS FORM Personal Information: You must: > Complete all sections of this form > Sign the form Name Last First Middle Maiden Suffix > Mail or hand deliver this form to your County Circuit Clerk AT LEAST 30 DAYS before the election. Home/Residence / 911 address City ZIP Apt or Lot # Secretary of State Delbert Hosemann Elections Division 401 Mississippi Street Jackson, Mississippi 39205 www.ms.sos.gov electionanswers@ms.sos.gov Hotline (800) 829-6786 If you are qualified and the information on your form is complete, your County Circuit Clerk will mail a voter registration card that tells you where to vote. *** Identification Requirement *** If you do not have a driver's license or social security number, and this form is submitted by mail, and you have never registered to vote in the county you are now registering in, you must send with this application, either : a) a copy of current and valid photo identification; or b) a copy of a current utility bill, bank statement, government check, paycheck, or other governments document that shows your name and address. If you do not provide the information requested above, you may be required to provide to election officials either (a) or (b) above the first time you vote after January 1, 2004 at a voting place or by absentee ballot. Disenfranching Crimes: Under state law, if you have been convicted of committing one of the following crimes your right to vote has been revoked: Arson, Armed Robbery, Bigamy, Bribery, Embezzlement, Extortion, Felony Bad Check, Felony Optional: Home # Work # Cell # EMail Date of Birth Con tact Number Cou nty of Residence Mailing Address (if different from home address - ex: P.O. Box) Required Information Mississippi Driver's License Number ( I f y o u do no t ha ve a MS dri ve r's Lic en se, the n pr ovi de the last 4 digits of your Social Security Number) Previous Address (including out of State) Previous County Declaration and Affidavit: I swear/affirm that: I have never been convicted of a disenfranchising crime, or I have had my rights restored as required by law. I have not been declared mentally incompetent by a court. Furthermore, I certify that I have truly answered all questions on this application for registration, and that I will faithfully support the Constitution of the United States and of the State of Mississippi, and will bear true faith and allegiance to the same. Signature (or mark) of applicant Date Shoplifting, Forgery, Larceny, Larceny under Lease or Rental Agreement, Murder, Obtaining Money or If applicant is unable to sign, the person who assisted the applicant must sign above. Date Goods under False Pretense, Perjury, Rape, Receiving Stolen Property, Robbery, Theft, Timber Larceny, Unlawful Taking of Motor Vehicle, Statutory Rape, or Carjacking. False registration is a felony. The penalty for conviction of false registration is imprisonment for not more than five (5) years or a fine of not more than five thousand dollars ($5,000), or both. 1 Mississippi Administrative Code Pt. 10, Exhibit F. County Election Commissioner Per Diem Claim Form. REPEALED.