On the reverse side of the envelope prescribed in § 10109 shall be printed a blank form of an affidavit in substantially the following form: “AFFIDAVIT District or Municipality of___________________________, Guam I, __________________________, do solemnly swear that the (Print or type full name) following matters relating to my qualifications for registration and voting are true:
Place of Residence: ___________________ (municipality, municipal, division or district), Guam. Date of Birth: __________________________ (Month/Day/Year) Place of Birth: __________________________ Method of which United States citizenship was attained:
Qualified voter: __________ (yes or no) That I am not confined to a mental institution or judicially declared incompetent; that I am not serving a criminal sentence; that I am not voting in any other U.S. jurisdiction; that I am in the business/work of _____________________; and that I shall be absent from the polls on the day of election on account of ______________.
________________________ Signature Subscribed and sworn to before me this ____ day of ______, 20___, and I hereby certify that the affiant exhibited the enclosed ballot to me unmarked; that the affiant then in my presence and of no other person, and in such manner that I could not see his vote, mark such ballot and enclosed and sealed same in this envelope; and that the affiant was not solicited or advised by me for or against any candidate or measure. _________________________ Print or type full name _________________________ Signature _________________________ Title or Rank” SOURCE: GC § 2458. Amended by P.L. 11-209:16 (Dec. 22, 1972); P.L. 12-149:21 (June 19, 1974). Codified as 3 GCA § 10110. Repealed and reenacted by P.L. 31-255:2 (Dec. 11, 2012).