Nevada Regulations § 293.208 Declaration of registered voter with a disability

DECLARATION OF REGISTERED VOTER WITH A DISABILITY

I am a registered voter with a disability.

I am a citizen of the United States.

I will be at least 18 years of age on election day.

I have not been adjudicated mentally incompetent, or if so, my right to vote has been restored.

I am not registered to vote in any other jurisdiction in the United States.

I have not applied, nor do I intend to apply, for a ballot from any other jurisdiction for the same election.

The information on this form is true and complete to the best of my knowledge.

I acknowledge that if I return my voted ballot by approved electronic transmission, I have waived my right to have my ballot kept secret. Nevertheless, I understand that my signature will be permanently separated from my voted ballot to maintain its secrecy at the outset of the tabulation process and thereafter.

I understand that a material misstatement of fact in completing this document may be grounds for a conviction of perjury under the laws of the United States or this State.

I declare under penalty of perjury under the laws of the United States and this State that the foregoing is true and correct.

(Signed)

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YOUR BALLOT CANNOT BE COUNTED UNLESS YOU SIGN THE ABOVE DECLARATION AND INCLUDE IT WITH YOUR BALLOT.

DECLARATION OF REGISTERED VOTER WITH A DISABILITY

I am a registered voter with a disability.

I am a citizen of the United States.

I will be at least 18 years of age on election day.

I have not been adjudicated mentally incompetent, or if so, my right to vote has been restored.

I am not registered to vote in any other jurisdiction in the United States.

I have not applied, nor do I intend to apply, for a ballot from any other jurisdiction for the same election.

The information on this form is true and complete to the best of my knowledge.

I understand that a material misstatement of fact in completing this document may be grounds for a conviction of perjury under the laws of the United States or this State.

I declare under penalty of perjury under the laws of the United States and this State that the foregoing is true and correct.

(Signed)

...........................................................

YOUR BALLOT CANNOT BE COUNTED UNLESS YOU SIGN THE ABOVE DECLARATION AND INCLUDE IT WITH YOUR BALLOT.