Florida Statutes Title IX. Electors and Elections § 101.6921. Delivery of special vote-by-mail ballot to certain first-time voters

Note:  Please Read Instructions Carefully Before Marking Ballot and Completing Voter's Certificate.

I, _______________, do solemnly swear or affirm that I am a qualified and registered voter of _______________ County, Florida, and that I have not and will not vote more than one ballot in this election.  I understand that if I commit or attempt to commit any fraud in connection with voting, vote a fraudulent ballot, or vote more than once in an election, I can be convicted of a felony of the third degree and fined up to $5,000 and/or imprisoned for up to 5 years.  I also understand that failure to sign this certificate will invalidate my ballot.  I understand that unless I meet one of the exemptions below, I must provide a copy of a current and valid identification as provided in the instruction sheet to the supervisor of elections in order for my ballot to count.

I further certify that I am exempt from the requirements to furnish a copy of a current and valid identification with my ballot because of one or more of the following (check all that apply):

☐ I am 65 years of age or older.

☐ I have a permanent or temporary physical disability.

☐ I am a member of a uniformed service on active duty who, by reason of such active duty, will be absent from the county on election day.

☐ I am a member of the Merchant Marine who, by reason of service in the Merchant Marine, will be absent from the county on election day.

☐ I am the spouse or dependent of a member of the uniformed service or Merchant Marine who, by reason of the active duty or service of the member, will be absent from the county on election day.

☐ I am currently residing outside the United States.

 (Date)  Voter's Signature