I hereby declare under penalties of perjury that I am qualified to vote, or to affix my authorized signature in the name of an entity which is entitled to vote, in this election. | ||
Subscribed and sworn to before me this ______ day of ______, 20______ | ||
__________________ | ||
Authorized Signature | ||
__________________ | __________________ | |
Printed Name of Voter | Signature of notary or other officer authorized to administer oaths. | |
__________________ | ||
Mailing Address of Voter (if different) |
§ 238.216, RSMo