Voting record form

(a) On the back of each registration form (or on a separate form if an alternate electronic registration system is used), there shall be printed a ten-year voting record form substantially as follows:VOTING RECORDName of VoterYEAR  PARTY General    Primary    Other         Election    Election    Elections         Ballot No. or  Ballot No. or  Ballot No. or         Ballot     Ballot     Ballot         Application   Application   Application         Number    Number    Number1971        1972        Continued forremainder often (10) years

VOTING RECORDName of VoterYEAR  PARTY General    Primary    Other         Election    Election    Elections         Ballot No. or  Ballot No. or  Ballot No. or         Ballot     Ballot     Ballot         Application   Application   Application         Number    Number    Number1971        1972        Continued forremainder often (10) years

YEAR  PARTY General    Primary    Other

Election    Election    Elections

Ballot No. or  Ballot No. or  Ballot No. or

Ballot     Ballot     Ballot

Application   Application   Application

Number    Number    Number

1971

1972

Continued for

remainder of

ten (10) years

(b) The year dates printed in the first column shall be changed with each year's printing of the form.