VOTER CHALLENGE

							                                         VOTER CHALLENGE
                                                                                            1-9-201, CRS.

 At the Regular Election of the                                                           District held on
                                                May 4, 2010.

        Name of Person Challenged:


        Specific Factual Basis for the Challenge:

                                                                       Citizenship
                                                                       Residency
                                                                       Age
                                                                       Property Owner
                                                                       Other


        Challenger Statement Under Penalty of Perjury (1-9-202, CRS)

        I swear or affirm, under penalty of perjury, that I am eligible to challenge and that to the
best of my belief, the person named above does not fulfill the requirements of an elector
shown above, as required by law, and is not entitled to vote at this election.



                                                                                  Signature of Challenger


                                                                              Printed Name of Challenger


                                                                                        Telephone Number



                                                             Signature of Election Judge Administering the
                                                                                 Challenger’s Oath


         An Election Judge shall ask the person challenged the pertinent questions as pertains to the
specific factual basis for the challenge (1-9-203, CRS):

CHALLENGE: CITIZENSHIP

Are you a citizen of the United States?                                Yes                  No

CHALLENGE: RESIDENCY

1. Have you resided in this state and the special district for the thirty (30) days immediately
    preceding this election?                                    Yes                    No

2. Have you been absent from this special district during the thirty (30) days immediately
    preceding this election?                                  Yes                   No




Division of Local Government – Department of Local Affairs- 2010 Election       B-59 Replaces B-59 & B-60
Rerevised 6/12/2009                                                                            Page 1 of 3
                                    VOTER CHALLENGE, con’t.

2a. During that time have you maintained a home or domicile elsewhere?
                                                            Yes                               No

3. If so, when you left, was it for a temporary purpose with the intent of returning, or did you
    intend to remain away?                                     Yes                     No

4. Did you, while absent, look upon and regard this state as your home?
                                                             Yes                              No

5. Did you, while absent, vote in any other state or any territory of the United States?
                                                               Yes                    No


CHALLENGE: AGE
To the best of your knowledge and belief, are you eighteen (18) years of age or older?
                                                             Yes                    No


CHALLENGE: PROPERTY OWNERSHIP

1. Are you a property owner or the spouse of a property owner in this political subdivision and
    therefore eligible to vote?                            Yes                      No

2. What is the address or, for special district elections where an address is not available, the
   location of the property which entitles you to vote in this election?




                                                                            Signature of Challenged Elector


                                                                                             Printed Name


                                                                                        Telephone Number



                                               WITHDRAWAL

        I HEREBY WITHDRAW THE ABOVE CHALLENGE.




                                                                                 Signature of Challenger




Division of Local Government – Department of Local Affairs- 2010 Election        B-59 Replaces B-59 & B-60
Rerevised 6/12/2009                                                                             Page 2 of 3
                                    VOTER CHALLENGE, con’t.


JUDGE – COMPLETE THE FOLLOWING:

1.      Was the challenge withdrawn?                      Yes              No
2.      Did the challenged elector refuse to answer questions concerning her/his qualification?
                                                          Yes              No
3.      Did the challenged elector leave the polling place without voting?
                                                          Yes              No




If the person refuses to answer fully any question which is asked, or refuses to sign the
Challenge Form, or refuses to take the oath, OFFER THE PERSON A PROVISIONAL BALLOT.
ATTACH THE CHALLENGE FORM TO THE PROVISIONAL BALLOT ENVELOPE AND INDICATE
“CHALLENGE” ON THE PROVISIONAL BALLOT ENVELOPE. (1-9-201(1)(b),CRS)




PROCEDURAL INSTRUCTIONS: Challenges may be made by an election judge, watcher or any
eligible elector of the District. All challenges must be made in writing. No oral challenge shall be
permitted. All challenges shall be provided to the Designated Election official.


Division of Local Government – Department of Local Affairs- 2010 Election     B-59 Replaces B-59 & B-60
Rerevised 6/12/2009                                                                           Page 3 of 3