For the purpose of this article, for all absentee ballots that are cast in person at the office of the registrar, the absentee ballot application and the required elector certificates shall be printed on the same form, with the application being printed on the front side of the form and the elector’s certificates printed on the back side of the form. Such form shall not be smaller than eight and one-half (8-1/2) inches by eleven (11) inches. Once a voter has completed the application and the elector’s certificate, he or she shall proceed to cast his or her absentee ballot and then place the ballot in the OMR equipment as otherwise provided by law. For the in-person absentee ballot application form, the elector’s certificate and other certificates shall appear as follows: ELECTOR’S CERTIFICATE STATE OF COUNTY OF I,, under penalty of perjury do solemnly swear that I am authorized by law to cast an in-person absentee ballot and the ballot cast by me indicates my choice of the candidates or contests to be submitted at the election to be held on the day of , 2. Penalties for vote fraud are up to five (5) years in prison and a fine of up to Five Thousand Dollars ($5,000.00), as provided in Section 23-15-753, Mississippi Code of 1972. Penalties for voter intimidation are up to one (1) year in jail and a fine of up to One Thousand Dollars ($1,000.00), as provided in Section 97-13-37, Mississippi Code of 1972. (Signature of Voter) SWORN TO AND SUBSCRIBED before me, this the day of . (Registrar or Deputy Clerk) CERTIFICATE OF PERSON PROVIDING VOTER ASSISTANCE (To be completed only if the voter has requested assistance in marking their ballot.) I, under penalty of perjury, hereby certify that the above-named voter declared to me that he or she is blind, temporarily or permanently physically disabled, or cannot read or write, and that the voter requested that I assist the voter in marking the enclosed absentee ballot. I hereby certify that the ballot preferences on the ballot are those communicated by the voter to me, and that I will mark the ballot in accordance with the voter’s instructions. Penalties for vote fraud are up to five (5) years in prison and a fine of up to Five Thousand Dollars ($5,000.00), as provided in Section 23-15-753, Mississippi Code of 1972. Penalties for voter intimidation are up to one (1) year in jail and a fine of up to One Thousand Dollars ($1,000.00), as provided for in Section 97-13-37, Mississippi Code of 1972. (Signature of person providing assistance) (Printed name of person providing assistance) (Address of person providing assistance) (Date and time assistance provided)
ELECTOR’S CERTIFICATE STATE OF COUNTY OF I,, under penalty of perjury do solemnly swear that I am authorized by law to cast an in-person absentee ballot and the ballot cast by me indicates my choice of the candidates or contests to be submitted at the election to be held on the day of , 2. Penalties for vote fraud are up to five (5) years in prison and a fine of up to Five Thousand Dollars ($5,000.00), as provided in Section 23-15-753, Mississippi Code of 1972. Penalties for voter intimidation are up to one (1) year in jail and a fine of up to One Thousand Dollars ($1,000.00), as provided in Section 97-13-37, Mississippi Code of 1972. (Signature of Voter) SWORN TO AND SUBSCRIBED before me, this the day of . (Registrar or Deputy Clerk) CERTIFICATE OF PERSON PROVIDING VOTER ASSISTANCE (To be completed only if the voter has requested assistance in marking their ballot.) I, under penalty of perjury, hereby certify that the above-named voter declared to me that he or she is blind, temporarily or permanently physically disabled, or cannot read or write, and that the voter requested that I assist the voter in marking the enclosed absentee ballot. I hereby certify that the ballot preferences on the ballot are those communicated by the voter to me, and that I will mark the ballot in accordance with the voter’s instructions. Penalties for vote fraud are up to five (5) years in prison and a fine of up to Five Thousand Dollars ($5,000.00), as provided in Section 23-15-753, Mississippi Code of 1972. Penalties for voter intimidation are up to one (1) year in jail and a fine of up to One Thousand Dollars ($1,000.00), as provided for in Section 97-13-37, Mississippi Code of 1972. (Signature of person providing assistance) (Printed name of person providing assistance) (Address of person providing assistance) (Date and time assistance provided)