Rhode Island General Laws Title 17. Elections § 17-20-21. Certifying envelopes

The secretary of state shall cause to be prepared and printed and shall furnish with each mail ballot an envelope for sealing up and certifying the ballot when returned. The envelope shall be printed in substantially the following form:

“After marking ballot or ballots, fold and enclose in this envelope and seal it. Certify to statement hereon. Enclose in envelope addressed to board of elections, which must receive the envelope not later than the time prescribed by § 17-18-11 for the closing of polling places on the day of election.”

Date of Election: __________ City/Town of: __________

Certificate of Voter

Print Name of Voter

I swear or affirm, under penalty of perjury, that I am:

• I am a United States citizen;

• I am a resident and qualified voter of the State of Rhode Island;

• I am eligible to cast a mail ballot under the provisions of § 17-20-2; and

• I have not and will not vote elsewhere in this election.

I hereby attest under the pains and penalty of perjury, that the enclosed voted ballot was cast by me, and that the signature or mark on this certifying envelope was made by me.

Voter must sign full name here: __________

(If unable to sign name because of blindness, disability, or inability to read or write, the voter or their assistant shall mark a box to indicate the voter cannot sign due to blindness, disability, or inability to read or write and include the full name, residence address, signature, and optionally the telephone number and e-mail address, of the person who provided assistance to the voter on the certifying envelope provided by the secretary of state. The representation relating to the voter's inability to sign shall be made under the pains and penalties of perjury).