Voters Reidentification Questionnaire

The questionnaire to reidentify a voter shall be in substantially the following form: VOTERS REIDENTIFICATION QUESTIONNAIRE Date _____, 20 Name _________________________________________ (FIRST) (MIDDLE) (LAST) Legal Residence Address __________________________________________ STREET City or Town ___________________________________________________ State _________________________________________________________ Date of Birth _______ Sex _______ I now vote and I am a qualified elector in precinct or Beat No. _____, Box No. _____, Coosa County, and I have not been disqualified from voting in this county. I am not a qualified voter in any other county in the State of Alabama or in any other state in the United States. I have resided in Precinct or Beat No. ____ for the past _____ months. Signed _________ Signature of Worker Sworn and subscribed before me this ____ day of ____, 20_. Registrar - Judge of Probate (Acts 1978, No. 864, p. 1290, §9.)