BALLOT RECORD AND RECEIPT

Example 1 FORM 1-K (Rev.-03) Prescribed by the Iowa Secretary of State BALLOT RECORD AND RECEIPT Precinct__________________________ Polling place name: __________________________________ Polling place address: _________________________________________________________________ (instructions are printed on the back) Number Delivered Ballots Delivered to the Precinct Date | Time Delivered to (Print Name) Type of Ballot Delivered to (Signature of Recipient) *Total Delivered Type of Ballot Voted & Counted Ballots Returned from the Precinct Disputed Spoiled (Special) Provisional Not Voted Number Returned Number of ballots returned * Absentee Ballots Surrendered (& Not Counted) *The number of ballots returned must equal the number delivered. Total Ballots received from: __________________________________________________________________ Received by: ___________________Date: ____/____/____ Appendix – G Election Day Forms Time: _____ a.m.: _____ p.m. 1 1 FORM 1-K (Rev.-03) (Backside of Ballot Record and Receipt) Iowa law requires that records be kept of the number of ballots delivered to and returned from each precinct. These records are an important administrative audit trail to help you keep track of vital election documents -- the ballots. The may also be very important in recount proceedings or election contests. [See 49.65 & 50.10] Even if voting machines are used, you will provide each precinct with paper ballots for use by voters who are unable to use the machine. [See 49.90] You must also provide an emergency supply of paper ballots to be available if one or more voting machines malfunction. [See IAC 721 -- 22.5(47).] You will use at least one sheet for each precinct. If necessary, you may use more than one. After the election keep these records for 6 months -- 22 months if there were federal candidates on the ballot. "Type of ballot." If physically distinct ballots are used, indicate the quantity of each kind sent to the precinct. For example: public measure, candidate, township, and city. "Voted and counted ballots." Ballots that were counted by the precinct officials without any objections or unresolved disputes are returned in an envelope or container that must be sealed in the precinct. The seal must bear the signatures of all precinct officials. The seal should be placed on the envelope or container so that the package cannot be opened without breaking the seal. {50.12] "Disputed ballots." These are ballots that were deposited in the ballot box, but the precinct officials found them to be defective in some way. There are two types of disputed ballots. Ballots that were not counted because they were folded together so that they appeared to be cast as a single ballot; and ballots that were counted without unanimous agreement of the precinct board. [50.3, 50.4, 50.5] "Spoiled ballots." Voters who make errors in marking their ballots may return the spoiled ballots to the officials for a new one. The spoiled ballots are not counted, but must be returned to the commissioner. A receipt is required to be taken for spoiled ballots. [49.100 & 50.9] "Provisional ballots." Voters who are challenged as unqualified to vote, or whose names do not appear on the election register and whose registration in the county cannot be verified by the election officials, have the right to vote. The ballots cast by challenged voters are placed into individual envelopes and are considered by the special precinct board after the election. [49.79 - 49.81] "Not voted." All unused ballots must be accounted for and returned. [50.9] "Number returned." Add together the number of ballots voted and counted, disputed, spoiled, special ballots, and not voted for each type of ballot. This number should equal the number of ballots of each type that were delivered to the precinct. “Absentee Ballots Surrendered (Not counted)”. Absentee ballots are not counted at polling places. Some voters may bring absentee ballots to the polls, turn them in and vote at the polling place. Keep these ballots separate – Do Not examine or count them. Appendix – G Election Day Forms 2 1A INSTRUCTIONS FOR BALLOT RECORD AND RECEIPT Explanation of Terms Example 2 FORM 1-I (Rev.-03) Prescribed by the Iowa Secretary of State STATE OF IOWA AFFIDAVIT OF VOTER REQUESTING ASSISTANCE I declare that I am unable to vote without help due to blindness, inability to read English, or any other physical disability. I request the help of the two precinct election officials designated to help voters in this precinct OR another person of my choice. Please note: Under Federal law, a voter may not be assisted by the voter's employer, an agent of the voter's employer, or an officer or agent of the voter's union. [42 USC 1973aa-6] Print voter’s name: ________________________________________ Signature of voter: _________________________________________ Signature of precinct official: __________________________________ Election date: _____/_____/_____ * Reminder to precinct official: Please note on the election register that this person voted with assistance. Appendix – G Election Day Forms 32 Example 3 Appendix – G Election Day Forms 34 Example 4 STEP 1 To be completed by Precinct Official Reason for Provisional Ballot Precinct ________________ Election Date _____/_____/_____ Reason for Provisional Ballot (check all that apply): Voter did not have proper identification Absentee voter with no ballot to surrender Voter was challenged by another registered voter (attach the signed challenge to this envelope) X _______________________________________ Precinct Official Signature Date Form 1-H (Rev.08) Prescribed by the Iowa Secretary of State Appendix G Election Day Forms 4 Example 5 Statement to Person Casting a Provisional Ballot Voter’s Name _________________________________________ Reason for casting a provisional ballot (check all that apply): Absentee voter with no ballot to surrender Voter was challenged by another registered voter Reason: ___________________________________________________ Photo ID required, not provided Voter: Provide photo ID containing your name and picture Photo ID with expiration date required, not provided Voter: Provide one of the following: Iowa driver’s license, out-of-state driver’s license, non-driver ID, U.S. passport, U.S. military ID, ID card issued by employer, student ID issued by Iowa high school or college Proof of residence required, not provided Voter: Provide one of the following: bank statement, paycheck, utility bill, property tax statement, residential lease, government check, or other government document Your provisional ballot may be counted if you bring a copy of the identification listed above to this precinct before the polls close today or to the county auditor at the address listed below before ________ a.m./p.m. on _____________________ (date). Your right to vote will be reviewed by the Special Precinct Board. You have the right and are encouraged to make a written statement and submit additional written evidence to this board supporting your qualifications as a registered voter. Send to: ____________________, County Auditor ____________________ ____________________ If your ballot is not counted, you will be notified, by mail, of the reason why it was not counted. X ____________________________________ Precinct Official Signature Date Form 1-G (Rev.08) Prescribed by the Iowa Secretary of State Appendix G Election Day Forms 5 Example 6 STEP 2 To be completed by Voter Affidavit of Provisional Voter Name ______________________________________________ Date of birth _____/______/_____ Address ___________________________________________ I am a United States citizen, at least 18 years of age. I believe that I am a registered voter of this county and/or eligible to vote in this election. X _______________________________________ Voter Signature Date Form 1-H (Rev.08) Prescribed by the Iowa Secretary of State Appendix G Election Day Forms 6 Example 7 Form 8 Appendix – G Election Day Forms 7 8 Example 8 Form 2 Oath of Attester on Election Day Name of Attester I, ___________________________________________________ do solemnly swear or affirm all of the following: • I am a pre-registered voter in this precinct or I registered to vote in this precinct today, and a registered voter did not sign an oath on my behalf. I have not signed an oath attesting to the identity and residence of any other person in this election. County __________________________________ • I am a resident of: Precinct _______________________________ (*if applicable) *Rural Township _______________________________ *City ____________________________________ • I reside at: _______________________________________________________________________________ Street City • I personally know________________________________________________, and I personally know that this Name of Registrant registrant is a resident of Precinct ___________________________ County __________________________________ (*if applicable) *Rural Township _______________________________ *City ____________________________________ I understand that any false statement in this oath is a class “D” felony punishable by no more than five (5) years in confinement and a fine of at least $750 but not more than $7,500. Signature of Attester ________________________________________________________________________ Subscribed and sworn before me on ____________________________________ Date Signature of Precinct Election Official ________________________________________________________ Appendix G Election Day Forms 8 Example 9 FORM 1-B CHALLENGE OF VOTER QUALIFICATIONS CHALLENGER’S STATEMENT Notice to Challenger: A person shall not be challenged for reporting a change of address at the polls or registering to vote at the polls on Election Day as permitted by Iowa law. (Iowa Code section: 49.79) I challenge the qualifications of _______________________________ to vote at the ___________ Election held on _____/_____/_____ (date). The challenged person: Is not a citizen of the United States. Is not a resident at the address where the person is registered. Has falsified information on a registration form or on a declaration of eligibility. Was adjudged incompetent to vote. Is less than 18 years of age on Election Day. Is not a resident of the precinct where the person is offering to vote. Was convicted of a felony and voting rights have not been restored. Is deceased. Provide details for reason(s) checked above: _________________________________________________ ________________________________________________________________________________________ Affirmation by Challenger: I am a registered voter in ___________________ County, Iowa. I swear or affirm that information contained in this challenge is true. I understand that knowingly filing a challenge containing false information is an aggravated misdemeanor. Challenger, please note: This challenge will be rejected if it does not include all of the following information: Name of Challenger Address Street Address City State Zip Phone ( ) Signature If you wish to withdraw this challenge, you may notify: 1. The precinct election officials at this polling place on Election Day, or 2. The County Auditor in writing of the withdrawal before the special precinct board meets. The special precinct counting board will meet at _____________________________ (date and time). OFFICE USE ONLY: Keep the original of this form in your office. PROVIDE NOTICE: If this challenge was made in the Special Voters’ Precinct, provide notice of the challenge to the voter. Notice of this challenge was provided to the voter by: In Person Telephone Mail Fax Date and time of notice: ____/____/____ ____:____ am/pm Response received: ____/____/____ ____:____ am/pm Forms Prescribed by the Iowa Secretary of State: August 2008 Edition Appendix G Election Day Forms 9