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      25-1122d.   Advance voting; application for ballot, form; identification, form of. (a) The application for an advance voting ballot to be transmitted by mail shall be accompanied by an affirmation in substance as follows:

      Affirmation of an Elector of the County of ______________ and State of Kansas Desiring to Vote an Advance Voting Ballot

State of ______________, County of ______________, ss:

      I,

do solemnly affirm under penalty of perjury that I am a qualified elector of the ______________ precinct of the ______________ ward, residing at number _______________ on __________________ street, city of _________, or in the township of __________, county of __________, and state of Kansas. My date of birth is ______________________(month/day/year).

      I understand that if I have not previously voted in any election in this county and I have not previously submitted valid identification, I must provide one of the following forms of identification with this application in order to receive a ballot:

      (1)   A current and valid Kansas driver's license number or nondriver's identification card number; or

      (2)   the last four digits of my social security number; or

      (3)   a copy of a current and valid Kansas driver's license or nondriver's identification card, utility bill, bank statement, paycheck, government check, or other government document that shows my name and address.

      I am entitled to vote an advance voting ballot and I have not voted and will not otherwise vote at the election to be held on __________ (date). My political party is ________ (to be filled in only when requesting primary election ballots). I desire my ballots to be sent to the following address

_______________________________________
_______________________________________ Signature of voter.

      Note: False statement on this affirmation is a severity level 9, nonperson felony.

      (b)   The application for an advance voting ballot to be transmitted in person shall be accompanied by an affirmation in substance as follows:

      Affirmation of an Elector of the County of ______________ and State of Kansas Desiring to Vote an Advance Voting Ballot

State of ______________, County of ______________, ss:

      I,

do solemnly affirm under penalty of perjury that I am a qualified elector of the ______________ precinct of the ______________ ward, residing at number _______________ on __________________ street, city of _________, or in the township of __________, county of __________, and state of Kansas. My date of birth is ______________________(month/day/year).

      I understand that if I have not previously voted in any election in this county and I have not previously submitted valid identification, I must provide one of the following forms of identification with this application in order to receive a ballot: a current and valid Kansas driver's license or nondriver's identification card, utility bill, bank statement, paycheck, government check or other government document that shows my name and address.

      I am entitled to vote an advance voting ballot and I have not voted and will not otherwise vote at the election to be held on __________ (date). My political party is ________ (to be filled in only when requesting primary election ballots).

_______________________________________
_______________________________________ Signature of voter.

      Note: False statement on this affirmation is a severity level 9, nonperson felony.

      (c)   An application for permanent advance voting status shall be on a form prescribed by the secretary of state for this purpose. Such application shall contain an affirmation concerning substantially the same information required in subsection (a) and in addition thereto a statement regarding the permanent character of such illness or disability.

      (d)   Any application by a former precinct resident shall state both the former and present residence, address, precinct and county of such former precinct resident and the date of change of residence.

      History:   L. 1978, ch. 140, § 5; L. 1980, ch. 109, § 2; L. 1984, ch. 140, § 2; L. 1995, ch. 192, § 21; L. 1996, ch. 187, § 26; L. 2000, ch. 49, § 2; L. 2004, ch. 93, § 2; July 1.