Kansas Statutes Chapter 25. Elections § 25-1122d. Advance voting; application for ballot, form; identification, form of; rules and regulations

    Affirmation of an Elector of the County of __________ and State of Kansas Desiring to Vote an Advance Voting Ballot

State of _______________, County of _______________, ss:

I, ________________________________________________________________________________________________

do solemnly affirm under penalty of perjury that I am a qualified elector of the precinct of the __________ ward, residing at number __________ on _______________ street, city of ____________________, or in the township of ____________________, county of _______________, and state of Kansas. My date of birth is ____________________ (month/day/year).

    I understand that a current and valid Kansas driver's license number or Kansas nondriver's identification card number must be provided in order to receive a ballot. If I do not have a current and valid Kansas driver's license number or Kansas nondriver's identification card number, I must provide one of the following forms of identification with this application in order to receive a ballot:

     A copy of any one of the following types of photographic identification: A driver's license issued by Kansas or by another state or district of the United States, a state identification card issued by Kansas or by another state or district of the United States, a concealed carry of handgun license issued by Kansas or a concealed carry of handgun or weapon license issued by another state or district of the United States, a United States passport, an employee badge or identification document issued by a municipal, county, state, or federal government office or agency, a military identification document issued by the United States, a student identification card issued by an accredited post secondary institution of education in the state of Kansas, or a public assistance identification card issued by a municipal, county, state, or federal government office or agency.

    I am entitled to vote an advance voting ballot and I have not voted and will not otherwise vote at the election to be held on __________ (date). My political party is __________ (to be filled in only when requesting primary election ballots). I desire my ballots to be sent to the following address:

_____________________________________________

_____________________________________________

Signature of voter.

Note: False statement on this affirmation is a severity level 9, nonperson felony.

    Affirmation of an Elector of the County of ____________________ and State of Kansas Desiring to Vote an Advance Voting Ballot

    State of _______________, County of ____________________, ss:

I, ________________________________________________________________________________________________

do solemnly affirm under penalty of perjury that I am a qualified elector of the precinct of the __________ ward, residing at number __________ on _______________ street, city of ____________________, or in the township of ____________________, county of __________, and state of Kansas. My date of birth is _______________ (month/day/year).

I am entitled to vote an advance voting ballot and I have not voted and will not otherwise vote at the election to be held on __________ (date). My political party is __________ (to be filled in only when requesting primary election ballots).

_____________________________________________

_____________________________________________

Signature of voter.

Note: False statement on this affirmation is a severity level 9, nonperson felony.