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Minnesota Regulations § 8200.9960 CHALLENGES TO VOTER REGISTRATION, FORM TO BE USED UNDER MINNESOTA STATUTES, SECTION 204C.12, SUBDIVISION 2

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Regulation Text

I,_____, do hereby state under oath,
Name of person making challenge
I am:
( ) an election judge.
( ) a challenger authorized by Minnesota Statutes, section 204C.07 .
( ) a Minnesota voter.
I reside at_____,_____,
Street Address City or Township
Telephone number:_____
E-mail address (optional):_____
I challenge the registration of _____
Name of challenged voter
whose registration lists his or her residence as
_____ _____
Street Address City or Township
This challenge is based on my personal knowledge. The grounds for my challenge are:_____
_____
_____
(attach additional sheets of signed statement if necessary).
I swear or affirm that the information stated here is truthful.
__/__/____ _____
Date Signature of Challenger
Signed and sworn to or affirmed before me
__/__/____ _____
Date Signature of Election Judge
For Election Judge Use Only:
Challenge was administered by Election Judge:_____
Time:_____
( ) Voter refused to take challenge oath.
( ) Challenge was dismissed: Voter passed challenge and voted.
( ) Challenge was sustained: Voter failed challenge and did not vote.
Additional Comments:

History

32 SR 2055

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