Voters Reidentification Questionnaire

The questionnaire to reidentify a voter shall be in substantially the following form: VOTERS REIDENTIFICATION QUESTIONNAIRE Date ______, 20______ Name ____________________________________________________ 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. ______, Shelby 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 (Act 80–408, p. 567, § 9.)