§ Miss. Code § 23-15-635(untitled)

Form of elector's certificate, attesting witness certification, and voter
assistance certificate where county registrar is not attesting witness and voter is not absent
voter as defined in the Armed Forces Absentee Voting Law.
(1) The form of the elector's certificate, attesting witness certification and
certificate of person providing voter assistance on the back of the envelope used by
voters who do not use the registrar of their county of residence as an attesting
witness and who are not absent voters as defined in Section 23-15-673, shall be as
follows:
"ELECTOR'S CERTIFICATE
STATE
COUNTY
OF
OR
________
PARISH
OF
________
I, ________, under penalty of perjury do solemnly swear that this envelope
contains the ballot marked by me indicating my choice of the candidates or
propositions to be submitted at the election to be held on the ________ day of
________, 2________, and I hereby authorize the registrar to place this envelope in
the ballot box on my behalf, and I further authorize the election managers to open
this envelope and place my ballot among the other ballots cast before such ballots are
counted, and record my name on the poll list as if I were present in person and voted.
I
further
swear
that
I
marked
the
enclosed
ballot
in
secret.
Penalties for vote fraud are up to five (5) years in prison and a fine of up to
Five Thousand Dollars ($5,000.00). (Miss. Code. Ann. Section 23-15-753.) Penalties for
voter intimidation are up to one year in jail and a fine of up to One Thousand Dollars
($1,000.00).
(Miss.
Code.
Ann.
Section
97-13-37.)
__________________
(Signature of voter)
CERTIFICATE OF ATTESTING WITNESS
Under penalty of perjury I affirm that the above named voter personally appeared
before me, on this the ________ day of ________, 2________, and is known by me to be
the person named, and who, after being duly sworn or having affirmed, subscribed the
foregoing oath or affirmation. That the voter exhibited to me his blank ballot; that
the ballot was not marked or voted before the voter exhibited the ballot to me; that
the voter was not solicited or advised by me to vote for any candidate, question or
issue, and that the voter, after marking his ballot, placed it in the envelope, closed
and sealed the envelope in my presence, and signed and swore or affirmed the above
certificate.
__________________
(Attesting
______________
witness)
(Address)
__________________
(Official title)
____________________________________
(City and State)
CERTIFICATE OF PERSON PROVIDING VOTER ASSISTANCE
(To be completed only if the voter has received assistance in marking the enclosed
ballot.) I, under penalty of perjury, hereby certify that the above-named voter
declared to me that he or she is blind, temporarily or permanently physically
disabled, or cannot read or write, and that the voter requested that I assist the
voter in marking the enclosed absentee ballot. I hereby certify that the ballot
preferences on the enclosed ballot are those communicated by the voter to me, and that
I have marked the enclosed ballot in accordance with the voter's instructions.
Penalties for vote fraud are up to five (5) years in prison and a fine of up to
Five Thousand Dollars ($5,000.00). (Miss. Code. Ann. Section 23-15-753.) Penalties for
voter intimidation are up to one (1) year in jail and a fine of up to One Thousand
Dollars
($1,000.00).
(Miss.
Code.
Ann.
Section
97-13-37.)
____________________________________________
Signature
of
person
providing
assistance
____________________________________________
Printed
name
of
person
providing
assistance
____________________________________________
Address
of
person
providing
assistance
____________________________________________
Date
and
time
assistance
provided
____________________________________________
Family relationship to voter (if any)"
(2) The envelope used pursuant to this section shall not contain the form prescribed pursuant
to Section 23-15-719 and shall have printed on the flap on the back of the envelope in bold print
and in a distinguishing color, the following: "YOUR VOTE WILL BE REJECTED AND
NOT COUNTED IF THIS ENVELOPE IS NOT SIGNED ACROSS THE FLAP OF THIS
ENVELOPE BY YOU AND AN ATTESTING WITNESS."