election day duties from 7 am to 8 pm · elections administration webinar training series back to...

Elections Administration Webinar Training Series Back to Basics

ELECTION DAY DUTIES FROM 7 AM TO 8 PM

This session will address topics relating to the Election Day duties and responsibilities of election inspectors, focusing on the November 2012 general election.

Wednesday, September 19, 2012

9:00 a.m. – 11:00 a.m.

Program Presenters

Wisconsin Government Accountability Board Staff

SAMPLE FORMS

Sample Forms

Sample Ballots 1 GAB-101: Ballot Container Certificate 5 GAB-102: Certificate of Rejected Absentee Ballots 6 GAB-103: Used Certificate Envelopes of Absentee Electors 7 GAB-104: Inspectors’ Statement 9 GAB-105: General Purpose Tally Sheet 13 GAB-106: Board of Canvassers Statement 15 GAB-107: Supplemental Poll List 19 GAB-108: Inspectors’ Certificate of Provisional Ballots 20 GAB-123: Provisional Ballot Certificate Envelope 21 GAB-123r: Provisional Ballot Reporting Form 22 GAB-124: Absentee Ballot Log 23 GAB139: Authorization to Cancel Registration 24 GAB-141: Application for Presidential Ballot 25 Sample Type B Notice of Presidential and General Election 27 Sample Type C Notice of Referendum 29 Sample Type D Location and Hours of Polling Place 30 GAB-111: Notice of Election Fraud 31 GAB-113: Notice of Effect of Over-Voting 37 GAB-115: Voter Qualification Poster 38 GAB-116: Instructions for WI Mail-In Registrants and First-Time Voters 39 GAB-117: General Information on Voting Rights Notice 41 GAB-118: Contact Information 45 Sample Ward Map 46 Provisional Voting Information 47 Sample Poll List 49 Sample GAB-133: Certificate of Registration 51 GAB-141: Application for Presidential Ballot 53 GAB-131: Voter Registration Application 55

OFFICIAL BALLOT

FOR PARTISAN OFFICE NOTICE TO ELECTORS: THIS BALLOT MAY BE INVALID UNLESS INITIALED BY 2 ELECTION INSPECTORS. IF CAST AS AN ABSENTEE BALLOT, THE BALLOT MUST BEAR THE INITIALS OF THE MUNICIPAL CLERK OR DEPUTY CLERK. To vote for the candidate of your choice, make a cross (X) in the box at the RIGHT of the name of each candidate for whom you desire to vote. To vote for a person whose name does not appear on the ballot, write the person's name in the space provided. When voting for president or vice-president, you may vote only for the candidates on one ticket jointly or by writing in the names of persons in both spaces. A write-in vote only for a vice presidential candidate will not be counted.

REPUBLICAN DEMOCRATIC CONSTITUTION INDEPENDENT

FEDERAL FEDERAL FEDERAL FEDERAL

Vice President Paul Ryan …………………………..….. …………………………..…..

Vice President Joe Biden …………………………...….. ………………………………..

Vice President Jim Clymer ……………………….…….. ……………………………..

Vice President James P. Gray (Libertarian Party)

___________________

Vice President Filberto Ramirez, Jr. (Party for Socialism and Liberation)

___________________

Vice President Phyllis Scherrer (Socialist Equality Party)

____________________ Vice President Ben Manski (Green Party) ....................................................... .....................................................

CONGRESSIONAL CONGRESSIONAL CONGRESSIONAL CONGRESSIONAL United States Senator

Tommy G. Thompson ..............................................

United States Senator

Tammy Baldwin …………………….………….


……………………………….


Joseph Kexel

(Libertarian Party)


Nimrod Y. U. Allen, III

(I.D.E.A.) …………………………………..

Representative in Congress,

District ...

(insert name)

.............................................


District ...

(insert name)

...........................................

Representative in Congress, District …

……………………………….


District ...

(insert name)

(Statement of Principle) ……………………………………..

LEGISLATIVE AND STATE LEGISLATIVE AND STATE LEGISLATIVE AND STATE LEGISLATIVE AND STATE

State Senator, District ...

(insert name)

............................................


(insert name)

...........................................

State Senator, District … ……………………………….


(insert name)

(Statement of Principle) ....................................................

Representative to the

Assembly, District ...

(insert name)

...........................................

Representative to the

Assembly, District ...

(insert name)

...........................................

Representative to the Assembly, District … ……………………………….

Representative to the Assembly,

District ...

(insert name)

(Statement of Principle) .....................................................

District Attorney

(insert name)

..........................................

District Attorney

(insert name)

..........................................

District Attorney ……………………………….

District Attorney

(insert name)

(Statement of Principle) ....................................................

COUNTY COUNTY COUNTY COUNTY

County Clerk

(insert name)

...........................................

County Clerk

(insert name)

..........................................

County Clerk

(insert name)

...........................................

County Clerk

(insert name)

.................................................. Treasurer

(insert name)

...........................................

Treasurer

(insert name)

..........................................

Treasurer

(insert name)

............................................

Treasurer

(insert name)

(Statement of Principle) ...................................................

Register of Deeds

(insert name) ...........................................

Register of Deeds

(insert name) ..........................................

Register of Deeds

(insert name) ..........................................

Register of Deeds

(insert name)

................................................. Surveyor

(insert name)

..........................................

Surveyor

(insert name)

..........................................

Surveyor

(insert name)

..........................................

Surveyor

(insert name)

.................................................

Eliminate any offices not up for election

President Mitt Romney

President Virgil Goode

President Gary Johnson

President Gloria La Riva

President Jill Stein

President Jerry White

President Barack Obama

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OFFICIAL BALLOT

FOR PARTISAN OFFICE NOTICE TO ELECTORS: THIS BALLOT MAY BE INVALID UNLESS INITIALED BY 2 ELECTION INSPECTORS. IF CAST AS AN ABSENTEE BALLOT, THE BALLOT MUST BEAR THE INITIALS OF THE MUNICIPAL CLERK OR DEPUTY CLERK. To vote for the candidate of your choice, make a cross (X) in the box at the RIGHT of the name of each candidate for whom you desire to vote. To vote for a person whose name does not appear on the ballot, write the person's name in the space provided. When voting for president or vice-president, you may vote only for the candidates on one ticket jointly or by writing in the names of persons in both spaces. A write-in vote only for a vice presidential candidate will not be counted.

REPUBLICAN DEMOCRATIC CONSTITUTION INDEPENDENT

FEDERAL FEDERAL FEDERAL FEDERAL

Vice President Paul Ryan …………………………..….. …………………………..…..

Vice President Joe Biden …………………………...….. ………………………………..

Vice President Jim Clymer ……………………….…….. ……………………………..

Vice President James P. Gray (Libertarian Party)

___________________

Vice President Filberto Ramirez, Jr. (Party for Socialism and Liberation)

___________________

Vice President Phyllis Scherrer (Socialist Equality Party)

____________________ Vice President Ben Manski (Green Party) ....................................................... .....................................................

CONGRESSIONAL CONGRESSIONAL CONGRESSIONAL CONGRESSIONAL United States Senator

Tommy G. Thompson ..............................................


Tammy Baldwin …………………….………….


……………………………….


Joseph Kexel

(Libertarian Party)


Nimrod Y. U. Allen, III

(I.D.E.A.) …………………………………..


District ...

(insert name)

.............................................


District ...

(insert name)

...........................................

Representative in Congress, District …

……………………………….


District ...

(insert name)

(Statement of Principle) ……………………………………..

GAB-203Fed | Rev 2012-08 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: [email protected] November General Election (Presidential Year)

Eliminate any offices not up for election

President Mitt Romney

President Barack Obama

President Virgil Goode

President Gary Johnson

President Gloria La Riva

President Jill Stein

President Jerry White

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GAB-203ms | Rev 2012-08 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: [email protected] Fall General Election Ballot - Presidential Year (Eliminate any offices not up for election or party lines without a candidate)

OFFICIAL BALLOT FOR PARTISAN OFFICE

NOTICE TO ELECTORS: THIS BALLOT MAY BE INVALID UNLESS INITIALED BY 2 ELECTION INSPECTORS. IF CAST AS AN ABSENTEE BALLOT, THE BALLOT MUST BEAR THE INITIALS

OF THE MUNICIPAL CLERK OR DEPUTY CLERK.

IMPORTANT: USE A #2 PENCIL OR THE MARKING PEN PROVIDED. DO NOT USE RED INK!

To vote for the candidate of your choice, complete the arrow to the RIGHT of the candidate's name. To vote for a person whose name does not appear on the ballot, write the person's name on the line(s) provided and complete the arrow to the RIGHT of the line. When voting for president or vice president, you may vote only for the candidates on one ticket jointly or by writing in the names of persons in both spaces. A write-in vote only for a vice presidential candidate will not be counted.

FEDERAL LEGISLATIVE AND STATE (Cont.) REFERENDUM

President & Vice President Vote for one Representative to the Assembly Dist. __ Question 1: insert name ← Vote for one “Text of Question”

insert name insert name ←

Republican Republican

insert name ← insert name ←

insert name Democratic

Democratic insert name ←

insert name ← (Statement of Principle) YES insert name Independent NO

Constitution Write-In........................................................…. insert name ← District Attorney Vote for one

insert name insert name ← (Statement of Principle) Republican Independent insert name ← President…………………………….………….. Democratic Vice President…………………….………..….. insert name ← Write-In (Statement of Principle)

CONGRESSIONAL Independent

United States Senator Vote for one Write-In........................................................….

insert name ← COUNTY

Republican County Clerk Vote for one insert name ← insert name ←

Democratic Republican insert name ← insert name ←

(Statement of Principle) Democratic Independent insert name ← Write-In........................................................... Constitution Representative in Congress, Dist. __ insert name ← Vote for one (Statement of Principle)

insert name ← Independent Republican Write-In............................................................

insert name ← Treasurer Vote for one Democratic insert name ←

insert name ← Republican (Statement of Principle) insert name ← Independent Democratic Write-In........................................................... insert name ←

LEGISLATIVE AND STATE Constitution OFFICIAL BALLOT

State Senator, Dist. __ Vote for one insert name ← FOR insert name ← (Statement of Principle) PARTISAN OFFICE

Republican Independent insert name ← Write-In............................................................ November 6, 2012

Democratic Register of Deeds Vote for one for insert name ← insert name ← ______________________________

(Statement of Principle) Republican (insert municipality & ward(s) #) Independent insert name ← Write-In........................................................…. Democratic Ballot Issued By insert name ← Constitution ______________________________ insert name ← (Statement of Principle) ______________________________

Independent (initials of inspectors) Write-In............................................................ Absent Elector’s Ballot Issued by Surveyor Vote for one insert name ← ______________________________ Republican (initials of municipal clerk or deputy clerk) insert name ← Certification of Elector Assistance Democratic I certify that the within ballot was marked by me insert name ← for an elector, who is authorized under the law to Constitution have assistance upon request, and as directed by insert name ← the elector. (Statement of Principle) ________________________________ Independent (Signature of assisting individual) Write-In............................................................

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OFFICIAL PRESIDENTIAL BALLOT

NOTICE TO ELECTORS: THIS BALLOT MAY BE INVALID UNLESS INITIALED BY 2 ELECTION INSPECTORS. IF CAST AS AN ABSENTEE BALLOT, THE BALLOT MUST BEAR THE INITIALS OF THE MUNICIPAL CLERK OR DEPUTY CLERK. Make a cross (X) in the square at the RIGHT of the names of the candidates for whom you desire to vote, or write in the names of candidates for president and vice president in the space provided for the purpose. Vote in ONE square only. A write-in vote only for a vice presidential candidate will invalidate your vote.

Mitt Romney ................................................................................ President Paul Ryan ............................................................................... Vice President

Republican

Barack Obama ................................................................................ President Joe Biden ................................................................................. Vice President

Democratic

Virgil Goode .................................................................................... President Jim Clymer ............................................................................. Vice President

Constitution

Gary Johnson .................................................................................. President James P. Gray ......................................................................... Vice President

Libertarian Party

Gloria La Riva ................................................................................ President Filberto Ramirez, Jr. ............................................................. Vice President

Party for Socialism and Liberation

Jerry White .................................................................................... President Phyllis Scherrer ..................................................................... Vice President

Socialist Equality Party

Jill Stein ......................................................................................... President Ben Manski ............................................................................ Vice President

Green Party

......................................................................................................... President ................................................................................................. Vice President Write in

GAB-207 | Rev 2012-08 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: [email protected] Presidential-Only Ballot

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BALLOT CONTAINER CERTIFICATE for Regular and Irregular Ballots

We, the undersigned election inspectors, certify that we placed the ballots and other election records required by §7.51(3)(a), (c) and (5), Wis. Stats., from ______________Ward(s) of

Town the City of ________________________, __________________County, State of Wisconsin from the Village

election held on __________________________, __________ in this container for delivery to the municipal clerk.

The tamper-evident seal used to secure this container is numbered: ________________________________. GAB 5.01(2), Wis. Admin. Code

This is bag number ______________ of _____________ bags. (Please complete if more than one bag is required.

Election Inspectors

Dated this _________________day of _________________________, ___________. ************************************************************************************************************************************* This container, secured with a numbered seal with the ballots enclosed, shall be returned immediately to the municipal clerk. §7.51(3)(a) and (5), Wis. Stats. The municipal clerk shall provide for the delivery of county, state, federal and school ballots to the appropriate clerk. §7.51(5), Wis. Stats. If the municipality has designated a central counting location pursuant to §7.51(1), Wis. Stats., the municipal clerk or two inspectors shall transport the container to the central counting location designated by the municipal clerk. §5.85(5), Wis. Stats. ELECTION BALLOTS MAY ONLY BE DESTROYED UNDER THE PROVISIONS OF §.7.23(1)(h), (2), Wis. Stats.

GAB-101 (Rev. 6/2008) (Changed to G.A.B. 12/2009) The information on this form is required by §7.51, Wis. Stats., and GAB 5.01(2), Wis. Admin. Code. This form is prescribed by the Government Accountability Board, P.O. Box 7984, Madison, WI, 53707-7984, 608-266-8005, http://gab.wi.gov, Email: [email protected]. -5-

http://gab.wi.gov/

CERTIFICATE OF

REJECTED ABSENTEE BALLOTS We certify that the absentee ballots contained in this envelope were rejected by us at the election held in the _________________ Ward(s) Town of the Village

of _____________________________, __________________County, Wisconsin

City

on the ____________ day of ___________________________, ___________ for the reasons shown on the back of each certificate envelope. Each rejected certificate envelope was assigned a number and listed on the Inspectors’ Statement (GAB-104) and Absentee Ballot Log prepared and filed by us with the election returns.

Election Inspectors

Dated this ______________ day of ___________________________, __________. Election Inspectors Ballots of absentee voters which are rejected pursuant to the provisions of §6.88, Wis. Stats., shall be kept

in their certificate envelopes and returned enclosed in this carrier envelope to the municipal clerk. These ballots may not be counted, and the names of voters may not be entered on the poll list or assigned

a number on the registration list. Each ballot should be numbered and the reason for rejection listed on the back of the ballot, on the

Inspectors’ Statement (GAB-104), and on the Absentee Ballot Log. This envelope will be returned by the inspectors to the municipal clerk after the polls close. §6.88(3)(b),

Wis. Stats. Municipal and County Clerks The municipal clerk is responsible for delivery of this envelope to the county clerk by 4 p.m. on the day

following the election if a county, state or federal election is held in conjunction with the election for which these ballots were cast. If there is no county, state or federal election held in conjunction with this election, this envelope shall be kept by the municipal clerk or returned to the clerk responsible for administering the election for which the absentee ballots were cast. §7.51(3)(d), (5), Wis. Stats.

In the event of a recount, the county clerk or appropriate municipal clerk will return this envelope to the board of canvassers responsible for conducting the recount. §9.01, Wis. Stats.

GAB-102 | Rev 2011-12 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: [email protected]

This form is printed on a brown envelope. -6-

mailto:[email protected]

USED CERTIFICATE ENVELOPES OF

ABSENTEE ELECTORS We certify that the used certificate envelopes of absentee ballots contained in this envelope were offered for voting at an election held in the _________________ Ward(s) Town

of _____

of the Village

________________________, __________________County, Wisconsin

City

on the ____________ day of ___________________________, ___________. The certification on each absentee certificate envelope was executed in compliance with §§6.22, 6.24, 6.87, Wis. Stats. The ballots were placed in the proper ballot containers after a voting number was assigned to the absentee elector’s name on the poll list along with an indication that the elector voted absentee.

This form is printed on a white envelope.

Dated this ______________ day of ___________________________, __________.

Election Inspectors

Election Inspectors or Municipal Board of Absentee Ballot Canvassers (Election Officials) Election officials shall announce the name of each absentee elector. When the election officials find that the certification has been properly executed, and the absentee voter

is a qualified elector of the ward and has not voted in the election, they shall assign a voter number to the elector’s name on the poll list and the Absentee Ballot log, and enter an indication on the poll list that the elector voted absentee.

The election officials shall open the envelope containing the ballots so as not to deface or destroy the certification.

The election officials shall remove the ballots and deposit them in the proper ballot containers. §§6.88(3)(a), 7.52(3)(a), Wis. Stats.

Used certificate envelopes of absentee voters who have cast ballots shall be placed in this carrier envelope and returned to the municipal clerk after the polls close or upon completion of the absentee ballot canvass. §§7.51(3)(d), 7.52(4)(i), Wis. Stats.

Municipal and County Clerks The municipal clerk is responsible for delivery of this envelope to the county clerk by 4 p.m. on the day

following the election if a county, state or federal election is held in conjunction with the election for which these ballots were cast. If there is no county, state or federal election held in conjunction with this election, this envelope shall be kept by the municipal clerk or returned to the clerk responsible for administering the election for which the absentee ballots were cast. §7.51(3)(d), (5), Wis. Stats.

In the event of a recount, the county clerk or appropriate municipal clerk will return this envelope to the board of canvassers responsible for conducting the recount. §9.01, Wis. Stats.


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We, the undersigned election inspectors, certify the following is a true and correct statement for an election

held in the __________ ward(s) of the ____________________ of ______________________, County of (ward number(s) (Town, Village of City) (Name of Municipality)

___________________, State of Wisconsin, on the _______day of _______________, 20_____. (Name of County) (Day) (Month) (Year)

MUNICIPAL CLERK PROVIDES THE FOLLOWING INFORMATION:

Voting Unit Number ______________________ Memory Device Serial Number ___________________ Tamper-Evident Seal Serial Number _____________________________

THIS SECTION TO BE COMPLETED BY CHIEF INSPECTOR:

VOTING EQUIPMENT/BALLOT CONTAINER CHAIN-OF-CUSTODY RECORD

Tamper-evident seal number verified by chief inspector (CI): Pre-election________ Post-election _______ (CI initials) (CI initials)

Upon sealing the ballot bag or container to which this Inspectors’ Statement pertains, record the number of the tamper-evident seal used for this purpose here___________________________.

THIS SECTION TO BE COMPLETED BY ELECTION INSPECTORS AND VERIFIED BY CHIEF INSPECTOR: VOTER STATISTICS

Total number of voters (last voter number on poll list) _________ Number of absentee voters ___________ (Absentee voters and in-person voters. Do not include provisional voters.) Number of provisional ballots _________

Total Number of ballots cast_________ Number of ballots in excess of total number of voters _________

Number of votes cast on:

paper (hand count) ballots_________, optical scan ballots________, DRE (touch screen)_______

Signatures of Election Inspectors Time Worked ___________________________________ _________to________

___________________________________ _________to________

___________________________________ _________to________

CERTIFICATION OF CHIEF INSPECTOR I certify that: I have completed the required training administered by the State Elections Board, and have been duly certified as a Chief Inspector. I served as the Chief Inspector for the election described above for the time period indicated below. ________________________________ ENTIRE DAY FROM ____ TO: ____ (Signature of Chief Inspector)

________________________________ FROM ____ TO _____ (Signature of Chief Inspector)

The completed form is retained in the office of the Municipal Clerk.

A copy of the completed form is returned to each Clerk with the other election forms.

Municipal clerk provides other copies as needed. §7.51, Wis. Stats.

DO NOT SEAL IN BALLOT BAG!

a.m. p.m.

a.m.p.m.

a.m.p.m.

a.m. p.m.

Inspectors’ Statement

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Check box if no incidents were recorded for this election.

Incident Log (Please refer to the Election Day Manual for detailed procedures!) Incident Number

Incident Code (See glossary)

Description of Incident Time

Incident Occurred

Election Officials Initials

a.m.

p.m.

a.m. p.m.

a.m. p.m.

a.m. p.m.

a.m. p.m.

a.m. p.m.

a.m. p.m.

a.m. p.m.

a.m. p.m.

a.m. p.m.

a.m. p.m.

a.m. p.m.

a.m. p.m.

a.m. p.m.

a.m. p.m.

a.m. p.m.

a.m. p.m.

a.m. p.m.

a.m. p.m.

a.m. p.m.

a.m. p.m.

GAB-104 | Rev. 2012-04 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: [email protected]

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Quick Reference (Please refer to the Election Day Manual for detailed procedures!)

Code Description of Incident Procedure for Completing Inspectors’ Statement

RO RS

RW RD RB RV

Rejected Absentee Ballots—Absentee ballots are rejected if: The certificate envelope is open or appears to

have been opened and resealed. The elector did not sign the certificate envelope. There is no signature of a witness. The inspectors have reliable proof that the elector

has died before election day. Elector has voted more than one ballot of the same

type. Elector has already voted in this election.

1) List voter’s name and reason ballot was rejected. 2) Indicate the reason for rejection on the certificate

envelope 3) Mark the certificate envelope “Rejected # (serial

number).” 4) Place the envelope containing the ballot in the

Rejected Absentee Ballot envelope. 5) The elector’s name is not entered on the poll list. 6) Do not count the ballot.

D Defective Ballots which are remade by election officials

1) Describe why the ballot had to be remade (ex: voter used red pen, voter circled names rather than marking arrow, mutilated by postal equipment).

2) These ballots are labeled “Original Defective Ballot # (serial number)” and “Remade Defective Ballot # (same serial number).”

3) The “remade” ballots are inserted into the counter. 4) The “defective” ballots are bundled together,

marked and placed in the Original Ballots Envelope.

5) The Original Ballots Envelope is placed in the ballot container.

CA CC CR CF CI CV CD PV

Challenged Ballots and Provisional Ballots Ballots may be challenged because: The person is not at least 18 years of age. The person is not a citizen of the United States. The person has not resided in the election district

for at least 28 consecutive days. The person has a felony conviction and has not

been restored to civil rights. The person has been adjudicated incompetent. The person has voted previously in the same

election. The person claims to have a physical disability

that prevents them from signing the poll book but both inspectors did not agree.

A provisional ballot was issued because the elector was required to present I.D. and did not.

1) Complete the “Challenge Documentation” (Form EB-104C). (There should be one (EB-104C) for each challenged elector.)

2) Mark ballot “Challenged – Voter #___.” (Use voter number from poll list.)

3) Mark “challenged” next to voter’s name on the poll list.

4) Challenged ballots are inserted into the counter. 5) Bundle together, label “Challenged Ballots,” and place

in ballot container.

Refer to the Provisional Ballots section of the Election Day Manual for instructions on issuing provisional ballots.

VI Ballots where voter intent could not be determined and, therefore, votes could not be counted

1) Describe the issue that caused the inspectors to decide that voter intent could not be determined.

2) Mark ballot “Defective-Intent,” and assign a serial number.

3) Bundle together, mark “Defective-Voter Intent Could not be Determined,” and place in ballot container.

O “Objected To” Ballots Objected Ballots are ballots that a minority of inspectors felt should not be counted.

1) Count the vote the way the majority of the inspectors determined it should be counted.

2) Assign a serial number to ballot, and indicate reason for objection.

3) Bundle together, label “Objected to Ballots,” and place in ballot container.

X Other Occurrences or Irregularities Describe any other occurrences or irregularities at your voting site which may or may not affect the validity of the election.

GAB-104 | Rev. 2012-04 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: [email protected]

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Tally Sheet Showing results for the _________ ward(s) of the _____________ aldermanic district of the _______________________________ of ____________________________ in the County of ________________________________________ on the ___________ day of _______________________________________, 20 __________ as made by the election inspectors setting forth the total number of votes for each office, the names of all persons receiving votes, and the number of votes cast for each person. GIVE NUMBER OF LAST VOTE ON POLL LIST OR HIGHEST NUMBER ON REGISTRATION LIST __________________________ __________________________________________ Name of Party (Partisan Primary) INSTRUCTIONS: Insert office titles vertically and the names of all candidates horizontally next to office title. Office Names of Candidates Including Write-Ins 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100 Total Votes Cast

(In figures) 105 110 115 120 125 130 135 140 145 150 155 160 165 170 175 180 185 190 195 200

PRIMARY ELECTION

CONGRESSIONAL OFFICES

STATEWIDE OFFICES

LEGISLATIVE & DISTRICT ATTORNEY OFFICES

JUDICIAL & SUPERINTENDENT

COUNTY OFFICES

LOCAL OFFICES

SCHOOL DISTRICT OFFICES

REFERENDA

(town, village or city)

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TALLY Of the votes given in the

________________________________of ____________________________ (Town, Village or City)

County of __________________________________________________ State of Wisconsin on _____________________________________________, 20 _____

PRIMARY

__________________________________ Name of Party (Partisan Primary)

PRESIDENT OF THE UNITED STATES CONGRESSIONAL OFFICES STATEWIDE OFFICES LEGISLATIVE & DISTRICT ATTORNEY OFFICES JUDICIAL & SUPERINTENDENT COUNTY OFFICES LOCAL OFFICES SCHOOL DISTRICT OFFICES REFERENDA

NOTE: THIS STATEMENT IS TO BE MADE IN DUPLICATE, ONE TO BE FILED WITH THE MUNICIPAL CLERK AND THE OTHER TO BE DELIVERED TO THE COUNTY CLERK. FOR SCHOOL DISTRICT ELECTIONS, ONE COPY IS DELIVERED TO THE MUNICIPAL CLERK, AND THE OTHER IS DELIVERED TO THE SCHOOL DISTRICT. STATE OF WISCONSIN County of _______________________________________________ Received and filed this ________ day of ________________________, 20 _______.

_____________________________________________ (Signature of County Clerk)


CERTIFICATION

State of Wisconsin ) ) ss. County of __________________________________ )

We, the undersigned, certify that we are election inspectors for the

_______________ wards(s) of the _____________________

aldermanic district of the ___________________________________

of ____________________________________, State of Wisconsin,

for the primary or election held on the day of

________________________________, 20 ________.

We further certify that we have counted all the ballots cast in said ward or polling place, that the count was duly and legally made and that the results of the count shown on the within tally sheet statement is correct.

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

(Signatures of at least 3 Election Inspectors, including the chief inspector and one inspector representing each of the 2 major political parties. Any inspector or tabulator participating in the ballot count must sign the certification.) Dated ____________________________________, 20 __________

(town, village or city) ELECTION

-14-

Tabular Statement of Votes Cast

, WI (insert municipality and county, if county canvass insert county only)

(type of election) _______________ Election - _______________ (date of election)

Office:

Reporting Units:

Candidates:

Scattering

(for Counties only)

Total Votes Cast-Candidates:

Total Votes Cast-Office:

(For County Use Only)

For a Partisan Primary, insert political party

GAB-106 (Rev. 8/98-G.A.B. 12/09) Tabular - Board of Canvassers Report

-15-

Completing the Tabular Statement of Votes Cast Instructions For Municipal Canvass:

Write the name of your municipality, the kind of election - primary, spring, or special election, etc., and the date of the election in the heading.

Enter the complete name of the office with the seat or district number in the shaded area.

List the names of the candidates for the office in ballot order below the shaded area.

Make sure that all wards or ward combinations are listed in proper numerical order in the left hand column. The smallest number in a combination determines the order. (Example: Wards 1&4; Wards 2,6 & 7; and Wards 3&5.)

For each reporting unit, list the number of votes cast for each candidate.

Don’t forget the write-in votes - they must be listed individually by name.

Enter the total number of votes cast for each candidate at the bottom of the column. Please give the total number of votes cast (not voters!) for each office in the “Total Votes Cast-Office” space. This total is the sum of the vote totals for each candidate plus the write-ins.

Instructions For County Canvass:

Write the name of your county, the kind of election - primary, partisan primary, spring/general election, or special, etc., and the date of the election in the heading.

A separate report must be completed for each political party in a partisan primary only. Write in the name of the political party on the line provided.

Enter the complete name of the office with the branch or district number in the shaded area.

List the names of the candidates for the office in ballot order below the shaded area.

Please list all municipalities and wards in the correct order in the left hand column. The smallest number in a combination determines the order. (Example: Wards 1&4; Wards 2,6 & 7; and Wards 3&5.)

1. Towns, alphabetically, wards numerically. 2. Villages, alphabetically, wards numerically. 3. Cities, alphabetically, wards numerically.

Make sure that all wards or ward combinations are listed along with the municipality name. If a municipality is divided by wards, but combines them for voting purposes and reports one total, you must still identify the numbers of the wards being reported. (Example: Town of Anywhere, Wards 1&2. If a municipality is not divided by wards do not list “Ward 1.”)

For each reporting unit, list the number of votes cast for each candidate.

Don’t forget the scattering column - if there are no write-in votes for a reporting unit, list 0.

Enter the total number of votes cast for each candidate at the bottom of the column. Please give the total number of votes cast (not voters!) for each office in the “Total Votes Cast-Office” space. This total is the sum of the vote totals for each candidate plus the scattering.

Notes for Municipal and County Clerks:

Combining Reporting Units. A municipality may provide for combined wards by resolution up to 30 days* before the spring primary or election, if your population is under 35,000. It’s important to remember that for the spring primary and the spring election, wards in a municipality may be combined for judicial offices even though separate results may be required for county, municipal, or school district offices. The wards being combined must use the same polling place. *60 days before a September Primary or General Election.

Reporting for annexations requires special attention. As long as the area being annexed belongs to the same representative districts, i.e., congressional, legislative, and county supervisory districts, as the adjacent area to which it’s being annexed, then the annexed area is reported together with the adjacent area using the same ward number. But if the annexed area has different representative districts from its adjacent area or crosses county lines, the municipality is required by law to create a separate ward giving it the next consecutive number. All election results from this new ward must be reported under the new ward number.

GAB-106 Instructions, Board of Canvass Report -16-

Certification of the Board of Canvassers

We, the undersigned, certify that we are the members of the Board of Canvassers for . (insert municipality and county, if county canvass insert county only)

We certify that the attached Tabular Statement of Votes Cast and Summary Statement of the Board of Canvassers, canvassed and prepared by us, are correct and true as compiled from the original returns made to the __________________________________ Clerk. (County, Municipal, School District)

We further determine and certify that the following persons received the greatest and the next to greatest (for primary only) number of votes for the respective office for which each was a candidate on ________________________________. (Insert date of primary or election)

SECOND

OFFICE HIGHEST CANDIDATE HIGHEST CANDIDATE (For Primary Only) (Title of Office) (Name of Winning Candidate) (Name of Second Highest Candidate)

BOARD OF CANVASSERS (1) ________________ (2) _____________________________________ (3) _____________________________________

(4) _____________________________________

(5) _____________________________________ (Date) This document is signed by: For a municipal election – The inspectors when there is only one polling place and one set of election results. s.7.53(1), Stats. For a municipal election – The municipal board of canvassers when there are 2 or more reporting units. s.7.53(2)(a), Stats. For state and county elections – The county board of canvassers. s.7.60(2), Stats.

GAB-106(Rev.8/98 – G.A.B. 12/09) Certification - Board of Canvassers Report

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Summary Statement of the Board of Canvassers

_______________ Election - _______________, _____ The total number of votes cast for _______________________________ was _______ of which (insert office) received (candidate’s name)

________________________________ received _______ (candidate’s name) ________________________________ received _______ (candidate’s name) Scattering (for county only) received The total number of votes cast for _______________________________ was of which (insert office) ________________________________ received _______ (candidate’s name) ________________________________ received _______ (candidate’s name) ________________________________ received _______ (candidate’s name) Scattering (for county only) received The total number of votes cast for _______________________________ was of which (insert office) ________________________________ received (candidate’s name)

________________________________ received (candidate’s name) ________________________________ received (candidate’s name) Scattering (for county only) received

GAB-106(Rev.8/98-G.A.B.12/09) Summary Statement - Board of Canvassers Report

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Supplemental Poll List

Municipality:

Election Date:

(Ward) (Ballot Combo)









Page ________ of ________

(Notes)

(Address)

(Address)

(Address)

(Address)

(Address)

(Address)

(Address)

(Address)

(Address)

(Notes)

(Notes)

(Notes)

(Notes)

(Voter #) (Print Name)

(Notes)




(Notes)



(Notes)



(Notes)


(Signature)

(Signature)

(Signature)

(Signature)

(Signature)

(Signature)

(Signature)

(Signature)

(Signature)


WISCONSIN INSPECTORS’ CERTIFICATE OF PROVISIONAL BALLOTS

We certify that the provisional ballots contained in this envelope were cast by voters unable to provide the proof of residence required pursuant to §§6.36 (2)(b)2., 6.97, Wis. Stats., unable or unwilling to provide the driver license number required pursuant to §6.36(1)(a), Wis. Stats., GAB 3.04, or unable or unwilling to provide an acceptable form of photo identification pursuant to §6.79 (2)(a), 6.97 Wis. Stats., at the election held in the _________________ Ward(s)

Town

of _____

of the Village

________________________, __________________County, Wisconsin

City

On the ____________ day of ___________________________, ___________ Each provisional voter was assigned a serial number beginning PV#__. The number was recorded on the registration list, the back of the ballot, the Provisional Ballot Certificate Envelope (GAB-123), the Provisional Ballot Reporting Form (GAB-123r), the “Provisional Voting Information” sheet for the elector, and listed on the Inspectors’ Statement (GAB-104) prepared and filed by us with the election returns. Each voter was informed that in order for their ballot to be counted, they must provide the required proof of residence, driver license number or acceptable form of photo ID to the municipal clerk no later than 4:00 p.m. on the Friday following the election. Each voter was given “Provisional Voting Information” prepared by the Government Accountability Board.

Dated this ______________ day of ___________________________, __________.

Election Inspectors

Election Inspectors Provisional ballots of voters unable or unwilling to provide the proof of residence required by

§§6.36(2)(b)2., 6.97, Wis. Stats., the driver license number required by §6.36(1)(a), Wis. Stats., or an acceptable form of photo identification pursuant to §6.79 (2)(a), Wis. Stats. shall be kept in their certificate envelopes.

These ballots may not be counted, unless the voter returns with the required proof of residence, their driver license number, or an acceptable form of photo identification before the polls close.

The names of provisional voters are assigned a serial number (PV#__) that is recorded on the registration list, the back of the ballot, the Provisional Ballot Certificate Envelope (GAB-123), the Provisional Ballot Reporting Form (GAB-123r), the “Provisional Voting Information” sheet for the elector, and listed on the Inspectors’ Statement (GAB-104).

The back of the ballot should be marked “Section 6.97,” voted by the elector, placed in the completed provisional ballot certificate envelope and returned to the election inspectors.

The inspectors make a notation (including the PV#) that the voter was issued a provisional ballot on the Inspectors’ Statement (GAB-104).

The completed provisional ballot certificate envelopes containing the voted ballots are placed in this carrier envelope. This carrier envelope and any other provisional ballot carrier envelopes must also be placed a separate ballot bag, secured with a tamper-evident seal and labeled with “Provisional Ballots.”

Municipal Clerks The municipal clerk shall promptly notify the appropriate boards of canvassers that the clerk has

provisional ballots that may be counted if the voter provides the required proof of residence, driver license number or acceptable form of photo ID by 4:00 p.m. on the Friday following the election.

GAB-108 | Rev 2011-09 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | mail: [email protected]

This form is printed on a (insert color) envelope. -20-

PROVISIONAL BALLOT CERTIFICATE Ballot under Section 6.97, Wis. Stats.

Voter: Complete the information below and sign the certification in the presence of an election inspector who must also sign. Official Use Only: Date of Election (month/day/year) County PV # Municipality (check type and list name) Town Village City of

Ward #

Name (Last, First, Middle) including suffix

Street Address – include street number or fire number and name of street, or rural route and box number

City, State, Zip Phone #, including area code

Date of Birth (month/day/year) Are you a citizen of the United States? Yes No

Voter must supply the following information to the municipal clerk no later than 4:00 p.m. on the Friday following the election in order for this ballot to be counted: WI Driver License number Proof of Residence Photo I.D

CERTIFICATION OF VOTER I certify, subject to the penalties of §.12.13(3)(g), Wis. Stats., that I am a qualified elector of the ward and municipality in the county of the state of Wisconsin indicated above. I am eligible to vote in this ward at the election today. I understand that if I fail to submit the required information listed above to my municipal clerk no later than 4:00 p.m. on the Friday following the election, my ballot may not be counted.

_________________________________________________________________________

_________________________________________________________________________ Signature of Voter Date Signature of Election Inspector Date


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Provisional Ballot Reporting Form

Name and Address of Elector PV#

Absentee or In-

Person Elector

Reason Code

Type of Provisional Documentation

Provided

Method of Providing Missing

Information (In-person, Phone,

Mail, etc.)

Date and Time Elector Provided

Missing Information

Clerk or Election Inspector Name

Voter Number Issued (if Election Day, please just note

"Withdrawn: # on Poll List.")

The information on this form was communicated to the municipal clerk by :

Date Initials of person responsible for communication: ________

Date: _______________

Telephone ______ In person _______ Fax _______ Email _______

Time: _____________ a.m. p.m.

Copy is sent (or information relayed over the telephone) to the County Clerk and Provider on Election Night.

Page _____ of ______Primary or Election Date: / /

County:

Reporting Unit:

Municipality:

Polling Place Location:

Reason Codes for Issuing Provisional Ballot:

A. POR listed on Poll List and proof of residence could not be provided

B. Unable or unwilling to provide DL#

Chief Inspector Initials:

Time

a.m. p.m.

The information on this form was communicated to the relevant canvass boards by:

Telephone _____ In person ________ Fax ______ Email ________

GAB-123r | Rev. 2012-04 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: [email protected]

Absentee Ballot Log Municipality: Election Date:

Name and Ward App. Ballot Ballot Vote Ballot Address Received Issued Received Recorded Style


Page of-23-

AUTHORIZATION TO CANCEL REGISTRATION

NEW WISCONSIN RESIDENTS

______________________________________________________________________________________________

(Name of person authorizing cancellation of voter registration)

It is my intent to vote for President and Vice President in Wisconsin, under §.6.15, Wis. Stats.

I authorize the cancellation of my voting privileges at the following address:

_______________________________________________________________________________

(Former street address)

_______________________________________ ______________________ ________________

(Town, Village, or City) (State) (Zip Code)

I am not registered to vote at my previous address.

Date ______________ ______________________________________________ (Signature of new Wisconsin resident)

____________________________________________________

(Present Address)

GAB-139 (Rev.4/92) (Ref. 1/98) ____________________________________________________

§.6.15(2)(b), Stats.

AUTHORIZATION TO CANCEL REGISTRATION

NEW WISCONSIN RESIDENTS

______________________________________________________________________________________________

(Name of person authorizing cancellation of voter registration)

It is my intent to vote for President and Vice President in Wisconsin, under §.6.15, Wis. Stats.

I authorize the cancellation of my voting privileges at the following address:

_______________________________________________________________________________

(Former street address)

_______________________________________ ______________________ ________________

(Town, Village, or City) (State) (Zip Code)

I am not registered to vote at my previous address.

Date ______________ ______________________________________________ (Signature of new Wisconsin resident)

____________________________________________________

(Present Address)

GAB-139 (Rev.4/92) (Ref. 1/98) ____________________________________________________

§.6.15(2)(b), Stats.

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Application For Presidential Ballot - New Wisconsin Resident For Presidential Election to be held on November ____, ______. (check one): To the Clerk of , Town State of Wisconsin. Village City I, , do solemnly swear that: 1. I am a citizen of the United States, and before establishing my present residence in Wisconsin, my legal

residence was at: (check one):

Town (former street address) Village (former state) City 2. On the day of the next Presidential Election, I will be at least 18 years of age, and I have been a legal

resident of the State of Wisconsin at the following address since the date indicated: (check one):

Town (date established residency)

Village (present street address) City (present municipality and county)

3. I am qualified to vote for President and Vice President at the election to be held on November ____, ____ . 4. I have resided in Wisconsin for less than 28 days, and I am not voting at any other place in this election. I request an Official Presidential Ballot, in accordance with Wis. Stat. § 6.15. Signature of applicant __________________________________________________________________ Residence address _____________________________________________________________________ City _____________________________________, State ________________________ Zip ___________ State of Wisconsin ) ) ss. County of ) Subscribed and sworn to before me this ________day of _________________________, ______. _________________________________________________

(signature of municipal or deputy clerk or election inspector) Penalties for Violation. Whoever swears falsely to any absent elector affidavit under Wis. Stat. § 6.15, may be fined not more than $1,000 or imprisoned not more than 6 months, or both. Whoever intentionally votes more than once in an election may be fined not more than $10,000 or imprisoned not more than 4 years and 6 months, or both. GAB-141 (Rev.7/2012) The information on this form is required by Wis. Stat. § 6.15. -25-

INSTRUCTIONS FOR APPLICATION FOR PRESIDENTIAL BALLOT - NEW WISCONSIN RESIDENT

Any person who is a United States citizen, at least 18 years old on election day, who has moved into the State of Wisconsin less than 28 days before the presidential election, and is ineligible to vote absentee in his or her state of previous residence, may vote for president and vice president by completing this application and providing a valid proof of residence. If voter registration is required, a new Wisconsin resident making application for a presidential ballot need not be registered. A new Wisconsin resident can complete this application and vote for president and vice president either by absentee ballot in the office of the municipal clerk, or by voting at the polling place on election day. In addition to completing this application form (GAB-141) and providing a valid proof of residence, the elector also must complete a voter registration cancellation card (GAB-139). Both of these items are provided by the municipal clerk. They also can be obtained from an election inspector at the polling place on election day.

PROCEDURE FOR MAKING APPLICATION IN THE MUNICIPAL CLERK'S OFFICE 1. The new Wisconsin resident shows a valid proof of residence, completes the application form (GAB-141),

and the voter registration cancellation card (GAB-139).

2. If the new Wisconsin resident chooses to vote an absentee presidential ballot in the clerk's office, the municipal clerk provides the person with an absentee ballot certificate envelope (GAB-122) and a presidential ballot. The clerk must keep a list which includes the name, address, date of application, and the date on which the ballot was cast.

3. If the new Wisconsin resident making this application chooses to go to the polling place on election day to

vote, the municipal clerk must provide the person with a copy of the completed application form (GAB-141) to take to the polling place.

4. The municipal clerk must keep a separate list of all new Wisconsin residents who vote under the provisions

of Wis. Stat. § 6.15. The list must include the person's name, address, and date of application, and if voting by absentee ballot, the date of receipt of the voted ballot.

5. The municipal clerk shall send the voter registration cancellation card (GAB-139) to the elector's

municipality of previous residence.

PROCEDURE FOR VOTING FOR PRESIDENT AT THE POLLING PLACE 1. The new Wisconsin resident can show a valid proof of residence, complete this application (GAB-141), and

the voter registration cancellation card (GAB-139) at the polling place, or bring a copy of the application form that was completed in the municipal clerk's office.

2. The election inspector will provide the person with a paper ballot to vote for the offices of president and

vice president only. 3. The election inspectors shall indicate on the voter list next to the new Wisconsin resident's name that he or

she received only a presidential ballot. 4. The application form (GAB-141) and the voter registration cancellation card (GAB-139) are returned to the

municipal clerk along with the voter lists and other election documents.

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SAMPLE TYPE B NOTICE FOR GENERAL ELECTION WHEN THE OFFICE OF PRESIDENT APPEARS ON THE BALLOT (INCLUDES REFERENDA INSTRUCTIONS)

(Use with paper ballots, optical scan and touch screen voting systems.

Delete any language or paragraphs that do not apply to your election or type

of voting system.)

NOTICE OF PRESIDENTIAL AND GENERAL ELECTION AND

SAMPLE BALLOTS (insert date) OFFICE OF THE (insert name of county) COUNTY CLERK TO THE ELECTORS OF (insert name of county) COUNTY Notice is hereby given of a general election to be held in the several wards in the County of , on the ____ day of November, 20__, at which the officers named below shall be chosen. The names of the candidates for each office to be voted for, whose nominations have been certified to or filed in this office, are given under the title of the office and under the appropriate party or other designation, each in its proper column, together with the questions submitted to a vote, in the sample ballot below. INFORMATION TO ELECTORS Upon entering the polling place, an elector shall state his or her name and address and sign the poll book before being permitted to vote. Where ballots are distributed to electors, the initials of two inspectors must appear on the ballot. Upon being permitted to vote, the elector shall retire alone to a voting booth or machine and cast his or her ballot, except that an elector who is a parent or guardian may be accompanied by the elector's minor child or minor ward. An election official may inform the elector of the proper manner for casting a vote, but the official may not in any manner advise or indicate a particular voting choice. Where paper ballots are used, the elector shall make a cross (X) in the square at the right of the name of the candidate of his or her choice for each office for which he or she intends to vote. To vote for a person whose name does not appear on the ballot, the elector shall write in the name of the person of his or her choice in the space provided for a write-in vote. On referendum questions, the elector shall make a cross (X) in the square next to "yes" if in favor of the question, or the elector shall make a cross (X) in the square next to "no" if opposed to the question. Where an optical scan system is used, the elector shall fill in the oval or connect the arrow next to the name of the candidate of his or her choice for each office for which he or she intends to vote. To vote for a person whose name does not appear on the ballot, the elector shall write in the name of the person of his or her choice in the space provided for a write-in vote, and fill in the oval or connect the arrow on the write-in line. Where touch screen voting systems are used, the elector shall touch the screen next to the name of the candidate of his or her choice for each office for which he or she intends to vote. To vote for a person whose name does not appear on the ballot, the elector shall type in the name of the person of his or her choice in the space provided for a write-in vote. On referendum questions, the elector shall touch the screen next to "yes" if in favor of the question, or the elector shall touch the screen next to "no" if opposed to the question. An elector must cast a vote for President and Vice President jointly on one ticket. To vote for persons whose names do not appear on the ballot, write in the names of individuals for both offices on the lines provided. A write-in vote for only a vice presidential candidate will not be counted. Type B Notice -27-

Presidential and General Election Page Two The vote should not be cast in any other manner. Not more than five minutes time shall be allowed inside a voting booth. Unofficial ballots or a memorandum to assist the elector in marking his or her ballot may be taken into the booth and copied. The sample ballot shall not be shown to anyone so as to reveal how the ballot is marked. If an elector spoils a paper or optical scan ballot, he or she shall return it to an election official who shall issue another ballot in its place, but not more than three ballots shall be issued to any one elector. If the ballot has not been initialed by two inspectors or is defective in any other way, the elector shall return it to the election official who shall issue a proper ballot in its place. After casting his or her vote, the elector shall leave the voting booth, properly deposit the ballot, and promptly leave the polling place. The elector may spoil a touch screen ballot at the voting station before the ballot is cast. After an official paper ballot is marked, it shall be folded so that the inside marks do not show, but so the printed endorsements and inspectors' initials on the outside do show. The elector shall then deposit his or her folded ballots in the proper ballot box or deliver the ballots to an inspector for deposit, and leave the polling place promptly. After an official optical scan ballot is marked, it shall be inserted in the secrecy sleeve provided so the marks do not show. The elector shall then insert the ballot in the voting device and discard the sleeve, or deposit the ballot in the ballot box or deliver it to an inspector for deposit. If a central count system is used, the elector shall insert the ballot in the ballot box and discard the sleeve, or deliver the ballot to an inspector for deposit. The elector shall leave the polling place promptly. After an official touch screen ballot is cast, the elector shall leave the polling place promptly. An elector may select an individual to assist in casting his or her vote if the elector declares to the presiding official that he or she is unable to read, has difficulty reading, writing, or understanding English, or that due to disability is unable to cast his or her ballot. The selected individual rendering assistance may not be the elector's employer or an agent of that employer or an officer or agent of a labor organization which represents the elector. The following is a sample of the official ballot: (Insert official Presidential and General Election Ballots)

______________________________ , County Clerk

Type B Notice-General Election (Presidential)| Rev 2012-07 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 |

608-261-2028 | web: gab.wi.gov | email: [email protected] -28-

SAMPLE TYPE C NOTICE OF REFERENDUM NOTICE OF REFERENDUM (insert proper jurisdiction) (insert date of referendum election) NOTICE IS HEREBY GIVEN, that at an election to be held in the (insert the proper phrase here.

For a statewide referendum insert: several towns, villages, wards, and election districts of the State of Wisconsin. For a county,

town, village, city, or school district referendum insert: the title and name of the jurisdiction, such as: County of Dane), on (insert

date of election), the following proposed (insert: amendment to the Constitution of the State of Wisconsin, or: Resolution

of the County Board, Town Board, Village Board, City Council, or School District Board of Education), will be submitted to a vote of the people: (insert entire text of resolution directing the referendum)

The question will appear on the ballot as follows: (insert question as it will appear on the official referendum ballot)

EXPLANATION (insert statement here explaining the effect of both a "yes" and a "no" vote)

Done in the (insert municipality where signed), on (insert date of signing here).

(Signature of clerk giving notice)

(Title of clerk)

(NOTE: THE TYPE C NOTICE OF REFERENDUM IS PUBLISHED BY THE CLERK RESPONSIBLE FOR THE REFERENDUM ON THE DAY PRECEDING THE REFERENDUM ELECTION. IF A WEEKLY PAPER IS USED FOR PUBLICATION, THE NOTICE IS PUBLISHED IN THE CLOSEST PRECEDING ISSUE TO THE DAY BEFORE THE REFERENDUM ELECTION. IF A JURISDICTION CHOOSES TO POST THIS NOTICE IN LIEU OF PUBLICATION, THE NOTICE MUST BE POSTED NO LATER THAN ONE WEEK BEFORE THE ELECTION.) Type C Notice of Referendum | Rev 2011-12 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: [email protected]

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SAMPLE TYPE D NOTICE OF LOCATION AND HOURS OF POLLING PLACES LOCATION AND HOURS OF POLLING PLACE At the (election or primary) to be held on (insert date of primary or date of election), in the (Town, Village,

City, or School District) of (insert name of jurisdiction), the following polling place locations will be used for the wards indicated: Location Wards

(insert name of building and address) (insert ward or ward numbers)



ALL POLLING PLACES WILL OPEN AT 7:00 A.M. AND WILL CLOSE AT 8:00 P.M.

If you have any questions concerning your polling place, contact the municipal clerk. (NAME OF MUNICIPAL CLERK) (ADDRESS) (TELEPHONE) (OFFICE HOURS) (NOTE: THIS NOTICE MUST CONTAIN A STATEMENT ABOUT THE ACCESSIBILITY TO THE ELDERLY AND DISABLED FOR EACH POLLING PLACE. IF ANY POLLING PLACES ARE NOT ACCESSIBLE OR IN COMPLIANCE WITH FEDERAL LAW, CONTACT THE GOVERNMENT ACCOUNTABILITY BOARD.)

All polling places are accessible to elderly and disabled voters. (NOTE: THE TYPE D NOTICE IS PUBLISHED BY THE MUNICIPAL CLERK ON THE DAY BEFORE EACH PRIMARY AND EACH ELECTION HELD IN THE MUNICIPALITY. IF A WEEKLY PAPER IS USED FOR PUBLICATION, THE NOTICE IS PUBLISHED IN THE CLOSEST PRECEDING ISSUE TO THE DAY BEFORE EACH PRIMARY AND EACH ELECTION. IF A MUNICIPALITY CHOOSES TO POST THIS NOTICE IN LIEU OF PUBLICATION, THE NOTICE MUST BE POSTED NO LATER THAN ONE WEEK BEFORE THE PRIMARY OR ELECTION.) Type D Notice | Rev 2011-12 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: [email protected]

-30-

State of Wisconsin\Government Accountability Board

__________________________________________________________________________________________

KEVIN J. KENNEDY

Director and General Counsel

212 East Washington Avenue, 3rd Floor Post Office Box 7984 Madison, WI 53707-7984 Voice (608) 266-8005 Fax (608) 267-0500 E-mail: [email protected] http://gab.wi.gov

Notice of Election Fraud An elector, who is any person qualified to vote, may not intentionally do any of the following acts: 1. Vote at any election or meeting if he or she is not a qualified

elector and does not meet applicable residence requirements. 2. Falsely register to vote. 3. Make false statements to the municipal clerk, board of election

commissioners, or any other election official, whether or not under oath.

4. Register to vote in more than one place for the same election. 5. Impersonate a registered voter to vote at an election. 6. Pose as another person to vote at an election. 7. Vote more than once in the same election. 8. Show his or her marked ballot to any person. 9. Mark his or her ballot so it is identifiable as his or her ballot.

10. Obtain an official ballot and neglect or refuse to cast or return the ballot unless an absentee ballot.

11. Procure, assist, or advise another person to do any one of the acts described above.

A person who does any one of the above acts commits election fraud and may be fined a maximum of $10,000 or confined in the state prison for a maximum of 3 years, or both. Wis. Stat. § 12.13(1)(a)-(h).

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No person may do any of the following acts: 1. Falsify any information in respect to or fraudulently deface or

destroy a certificate of nomination, nomination paper, declaration of candidacy or petition for an election, including a recall petition or petition for a referendum; or file or receive for filing a certificate of nomination, nomination paper, declaration of candidacy or any such petition, knowing such is falsely made.

2. Prepare or cause to be prepared an official ballot with intent to change the result of the election as to any candidate or referendum.

3. Prepare an official ballot which is premarked or which has an unauthorized sticker affixed prior to delivery to an elector.

4. Deliver to an elector an official ballot bearing a mark opposite the name of a candidate or referendum question that might be counted as a vote for or against a candidate or question.

5. Before or during any election, tamper with voting machines, voting devices or automatic tabulating equipment readied for voting or the counting of votes.

6. Disarrange, deface, injure or impair any voting machine, device or equipment readied for voting or the counting of votes.

7. Mutilate, injure or destroy a ballot placed or displayed on a voting machine or device, or to be placed or displayed on any such machine, device or automatic tabulating equipment or any other appliance used in connection with the machine, device or equipment.

8. When called upon to assist an elector who cannot read or write, has difficulty reading, writing or understanding English, or is unable to mark a ballot or depress a lever or button on a voting machine, inform the elector that a ballot contains names or words different than are printed or displayed on the ballot with the intent of inducing the elector to vote contrary to her or her inclination, intentionally fail to cast a vote in accordance with the elector’s instructions or reveal the elector’s vote to any 3rd person.

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9. Forge or falsely make the official endorsements on a ballot. 10. Knowingly deposit in the ballot box a ballot on which the initials

of the election inspectors or the municipal or deputy clerk do not appear.

11. Break open or violate the seals or locks on a ballot box containing election ballots without authorization during or after the election.

12. Obtain possession of a ballot box with ballots without authorization during or after an election.

13. Conceal, withhold, or destroy a ballot box or ballots without authorization during or after an election.

14. Add fraudulently or forcibly to the ballots legally deposited in a ballot box without authorization during or after an election.

15. Reduce the number of legally deposited ballots in a ballot box without authorization during or after an election.

16. Aid or abet another person to do any of the acts described in paragraphs 11 through 15 above.

17. Fraudulently change a ballot of an elector so the elector is prevented from voting for whom the elector intended.

18. After an election, break the locks or seals or reset the counters on a voting machine, when not authorized.

19. Disable a voting machine so as to prevent an accurate count of the votes from being obtained.

20. Open the registering or recording compartments of a machine with intent to do any of the acts described in paragraphs 18 or 19 above.

21. Tamper with automatic tabulating equipment or any record of votes cast or computer program which is to be used in connection with such equipment to count or recount votes at any election so as to prevent or attempt to prevent an accurate count of the votes from being obtained.

A person who does any of the above acts commits election fraud and may be fined a maximum of $10,000 or imprisoned for a maximum

-33-

of 3 years, or both. Wis. Stat. §§ 12.13(3)(a), (e), (f), (j), (k), (L), (y), and (z). No person may do any of the following acts: 1. Wrongfully suppress, neglect or fail to file nomination papers in

the person’s possession at the proper time and in the proper office.

2. Suppress a certificate of nomination which is duly filed. 3. Willfully or negligently fail to deliver, after having undertaken to

do so, official ballots prepared for an election to the proper person, or prevent their delivery within the required time, or destroy or conceal the ballots.

4. Remove or destroy any supplies or conveniences placed in compartments or polling booths.

5. Falsify any affidavit or other statement relating to voter registration under Wis. Stat. Ch. 5 to 12.

6. Falsely make any statement for the purpose of obtaining or voting an absentee ballot under Wis. Stat. §§ 6.85 or 6.87.

7. Receive a ballot from or give a ballot to a person other than the election official in charge.

8. Vote or offer to vote a ballot other than a ballot received from one of the inspectors.

9. Receive a completed ballot from a voter unless qualified to do so. 10. Ask a person to show how he or she voted on a ballot. 11. Remove a ballot from a polling place before the polls are closed. 12. Ask another elector to offer assistance under Wis. Stat. §§ 6.82(2)

or 6.87(5), except in the case of an elector who is blind or visually impaired to the extent that the elector cannot read a ballot.

13. Obtain an absentee ballot as the agent of another elector under Wis. Stat. § 6.86(3) and fail or refuse to deliver it to such elector.

-34-

14. Present false documentation of identity for the purpose of inducing an election official to permit the person or another person to vote.

15. Falsify a ballot application under Wis. Stat. § 6.18. 16. Refuse to obey a lawful order of an election inspector made to

enforce the election laws. 17. Engage in disorderly behavior at or near a polling place. 18. Interrupt or disturb the voting or canvassing proceedings. 19. Compensate a person who obtains voter registration forms from

other persons at a rate that varies in relation to the number of voter registrations obtained by the person.

20. Willfully provide to a municipal clerk false information for the purpose of obtaining a confidential listing under Wis. Stat. § 6.47(2) for that person or another person.

21. Disclose to any person information provided under Wis. Stat. § 6.47(8) when not authorized to do so.

A person who does any of the above acts commits election fraud and may be fined a maximum of $1,000 or imprisoned not more than 6 months, or both. Wis. Stat. § 12.13 (3)(b), (c), (d), (g), (i), (n) to (u), (w), (x), (ze), (zm) or (zn).


-35-

NOTICE

EFFECT OF OVER-VOTING

You may only vote for the number of

candidates indicated on the ballot in each

contest. If you vote for more than that

number, no votes will be counted for that

office.

If you have over-voted your ballot, please return it to the election inspectors to receive a replacement ballot. You may receive no more than 2 replacement ballots.

NOTE: This notice is to be placed in the voting booth wherever a voter’s ballot is not automatically checked for overvotes (absentee, central count, or hand-count paper ballot).


-37-

Are You Qualified to Vote?

You may vote if:

You are a United States Citizen; You are 18 years or older today; You have lived here for 28 consecutive days before

this election with no present intent to move; and You are registered to vote or are registering today.

You may not vote if:

You are here for temporary purposes only; You have voted in this election already; You are still required to report to a probation or

parole officer because of a felony conviction; You have been ruled incapable of voting by a judge; You have placed a bet or a wager on the outcome

of this election.

If you have questions, please see an election inspector or the municipal clerk.

GAB-115 | Rev 2011-12 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707- 7984 | 608-261-2028 | web: gab.wi.gov | email: [email protected]

-38-


NOTICE

INSTRUCTIONS FOR WISCONSIN MAIL-IN REGISTRANTS

AND FIRST-TIME VOTERS

If you registered to vote by mail, did not provide proof of residency to the municipal clerk before election day and are voting in an election for the first time in Wisconsin,

YOU ARE REQUIRED TO:

Present proof of residency containing the following information to the election inspectors before being allowed to vote:

your complete name, including both the given and family name,

AND

your current and complete residential address, including a numbered street address, if any, and the name of the municipality.

Proof of Residency is limited to the following:

A current and valid operator’s license or identification card issued by the Department of Transportation.

An official identification card or license issued by a Wisconsin governmental body or unit.

An official identification card or license issued by an employer that includes a photograph of the cardholder or license holder, excluding a business card.

A property tax bill or receipt for the current or preceding year.


A current utility bill. A bank statement. A pay check. A government check or document. A college identification card that includes a photograph of the

cardholder, together with a fee payment receipt issued by the university, college, or technical college dated not earlier than 9 months before the date of the election at which the receipt is presented.

University or college students may also establish residency using a student ID with a photo if the university or college has provided a certified list to the municipal clerk of students, containing the students’ residential address and indicating which students are U.S. citizens.

If you do not present the required proof of residency you may vote a provisional ballot.


A current utility bill. A bank statement. A pay check. A government check or document. A college identification card that includes a photograph of the

cardholder, together with a fee payment receipt issued by the university, college, or technical college dated not earlier than 9 months before the date of the election at which the receipt is presented.

University or college students may also establish residency using a student ID with a photo if the university or college has provided a certified list to the municipal clerk of students, containing the students’ residential address and indicating which students are U.S. citizens.

If you do not present the required proof of residency you may vote a provisional ballot.

-39-

NOTICE

General Information on Voting Rights under Federal Laws as Applied to Wisconsin Voters

Voters whose names do not appear on the poll list are entitled to register to vote at the polling place by completing a voter registration application and providing acceptable proof of residence. Wis. Stat. § 6.55. Voters who are unable to comply with proof of residency requirements for mail-in registrants, are entitled to register to vote at the polling place by completing a voter registration application and providing acceptable proof of residence. 42 U.S.C. §§ 15482(a), 15483(b). Voters who vote in an election for federal office after the established time for polls to close due to a court order or other order requiring the polls to remain open extended hours will have to vote by provisional ballot (unless those voters were in line at the time polls closed). 42 U.S.C. § 15482(c). Note: Wis. Stat. § 6.96, provides that in the case of a court order extending the closing hour of the polling place, the ballot of an elector who is allowed to vote after the normal closing time will be marked with the statutory reference “s. 6.96,” and the ballot will be placed in the ballot box or container and counted with the other ballots. Voters may have to provide proof of residency information the first time they vote in an election, if they registered to vote for the first time in Wisconsin by mail and have not provided proof of residency to the municipal clerk before Election Day, unless they are entitled to vote absentee under federal law. 42 U.S.C. § 15483(b). Voters are entitled to notice of the disposition of their voter registration application. 42 U.S.C. § 1973gg-6(a)(2). -41-

Voters otherwise qualified to vote in an election for President or Vice-President may not be denied the right to vote for those offices due solely to a failure to satisfy a durational residency requirement. 42 U.S.C. § 1973aa-1. Voters who are otherwise qualified to register and vote may be entitled to register and vote absentee in an election for federal office if they are in the military or are residing overseas. 42 U.S.C. § 1973ff-1. Voters who require assistance in voting due to blindness, disability or inability to read or write may receive assistance from a person of the voter's choice other than the voter's employer (or agent thereof) or an officer of the voter's union (or agent thereof). 42 U.S.C. § 1973aa-6. Jurisdictions must not apply standards or practices which deny or abridge the right to vote on account of race, must not deny any individual the right to vote on account of errors or omissions in registration applications which are not material to determining whether such individual is qualified to vote, and must not apply different standards and procedures to voters in determining whether are they are qualified to vote. 42 U.S.C. §§ 1971(a), 1973. Jurisdictions must take steps to make the registration and voting process accessible to the elderly and to individuals with disabilities. 42 U.S.C. §§ 1973ee-1, 1973ee-2, 1973ee-3. Persons must not intimidate, threaten or coerce any other person: for registering or voting; for urging or aiding persons in registering or voting; for purposes of interfering or influencing how a person chooses to vote or not vote; or for purposes of preventing a person from voting. U.S.C. §§ 1971(b), 1973i(b), 1973gg-10(1); 18 U.S.C. §§ 241, 242, 245, 594.

-42-

Election officials must not fail or refuse to permit a person to vote who is entitled to vote and must not refuse to tabulate, count and report such person's vote. 42 U.S.C. § 1973i(a); 18 U.S.C. §§ 241, 242, 608(a). Election officials must not deny persons of any right secured by the 26th Amendment to the U.S. Constitution (regarding not denying the right to vote to citizens 18 years of age and older on account of age). 42 U.S.C. § 1973bb. Election officials must retain and preserve for 22 months after any election that includes a federal candidate all records and papers relating to registration and voting in that election. 42 U.S.C. § 1974.

General Information on Federal Laws Regarding Prohibitions on Acts of Fraud and Misrepresentation

Prohibited Acts of Fraud and Misrepresentation Persons must not make any false statement or claim that they are citizens of the United States in order to register or vote in any Federal, State, or local election. 42 U.S.C. § 15544(b); 18 U.S.C. §§ 611, 911, 1015(f). Persons must not vote more than once in any election that includes a federal candidate (note: this does not include voting a replacement ballot after a spoiled ballot was invalidated). 42 U.S.C. § 1973i(e). Persons must not procure or submit materially false, fraudulent or fictitious voter registration applications in any election that includes a federal candidate. 42 U.S.C. § 1973gg-10(2)(A).

-43-

Persons must not submit false information as to name, address or period of residence in a voting district for the purpose of establishing eligibility to register or vote in any election that includes a federal candidate. 42 U.S.C. §§ 1973i(c), 15544(a); 18 U.S.C. § 608(b). Persons must not procure, cast or tabulate materially false, fraudulent or fictitious ballots in any election that includes a federal candidate. 42 U.S.C. §§ 1973i(c),(e), 1973gg-10(2)(B); 18 U.S.C. § 242. Persons must not pay, offer to pay or accept payment for voting, registering to vote, withholding their vote, or voting for or against any candidate in any election that includes a federal candidate. 42 U.S.C. § 1973i(c), 18 U.S.C. §§ 597, 608(b).

NOTE: The information on this form is required by HAVA § 302(b) and Wis. Stat. §§ 5.35(6)(a)2m., 4b.

GAB-117 | Rev 2011-12 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: [email protected] -44-

NOTICE Contact Information

Reporting Fraud or Corruption

If you have witnessed efforts to commit any kind of fraud or corruption in the voting process, you may report this to state law enforcement officials at:

________ County District Attorney State of Wisconsin (insert county) Department of Justice ________ - ________ - _________ 608-266-1221 (insert phone number)

You may report this to federal law enforcement officials at:

United States Attorney’s Office United States Attorney’s Office Eastern District of Wisconsin Western District of Wisconsin 414-297-1700 608) 264-5158

Reporting Civil Rights Issues

If you have witnessed actual or attempted acts of discrimination or intimidation in the voting process, you may report this to the Civil Rights Division of the United States Department of Justice at 1-800-253-3931.

Reporting Concerns about the Voting Process

If you have questions or concerns about the voting process, including polling place accessibility, you may contact your municipal clerk at: ______-______-_________ (insert phone number)

You may also contact the Government Accountability Board at:

Toll-free number: 866-VOTEWIS (866-868-3947) Madison area: 608-261-2028 Email: [email protected]

This information is required by HAVA § 302 (b) and Wis. Stat. §§ 5.35(6)(a)4b., 5.


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City of Madison Ward 1Prepared by City of Madison Planning Division on 1/20/2012 ±

-46-

Provisional Voting Information Sheet for Voters | Rev 2011-12 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: [email protected]

PROVISIONAL VOTING INFORMATION

You are being given a provisional ballot today because one of the following situations apply:

You are unable or unwilling to list your driver’s license number on your voter registration application.

You are a first-time voter who registered by mail who is unable to provide the poll workers with

acceptable proof of residence. You failed to provide an acceptable form of proof of identification.

Your provisional ballot number is PV#____________________________. Your provisional ballot will not count unless you provide the poll workers with the required information before the polling place closes at 8:00 p.m. tonight, or you provide the required information to the municipal clerk by 4:00 p.m. the Friday after the election If you need to provide your driver’s license number, you may contact the municipal clerk using the information below no later than 4:00 p.m. Friday. If you need to provide proof of residence, you must provide it (or a copy) to the municipal clerk no later than 4:00 p.m. Friday. Acceptable forms of proof of residence may be found on the back side of this handout. If you need to show proof of identification, you must provide it (or a copy) to the municipal clerk no later than 4:00 p.m. Friday. Acceptable forms of proof of identification may be found on the back side of this handout. You may check whether your ballot was counted by contacting the municipal clerk.

Municipal Clerk Contact information: ______________________________________ ______________________________ (Name of municipal clerk) (Telephone number)

______________________________________ ______________________________ (Address) (Fax number)

______________________________________ ______________________________ (Municipality, state, zip code) (E-mail address) You may check whether your ballot was counted by contacting the municipal clerk or the Voter Public Access website at: https://vpa.wi.gov, or contact the Government Accountability Board at 866-VOTEWIS (868-3947).

NOTE: Provisional ballots will NOT be issued when a voter is at the wrong polling place or when

a person is attempting to register in-person at the polling place and does not provide the required

proof of residence.

-47-

Provisional Voting Information Sheet for Voters | Rev 2011-12 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: [email protected]

Acceptable Forms of Proof of Residence

Only one of the following is required:

A current and valid Wisconsin driver’s license A current and valid Wisconsin identification

card Any other official ID card or license issued by

a Wisconsin governmental body An ID card with your photo issued by an

employer during the normal course of business (not including a business card)

A real estate tax bill or receipt (for the current

year or year before the election) A residential lease which is effective for a

period that includes Election Day A university, college, or technical college

identification card (must include photo) together with a fee payment receipt issued to the cardholder by the university, college, or technical college dated no earlier than 9 months before the date of the election at which the receipt is presented

A utility bill for a period starting no earlier

than 90 days before Election Day A bank statement

A paycheck

A government check

Any other official document issued by a unit

of government NOTE: All of the above must contain a current and complete name, including both first and last name; and a current and complete residential address, including numbered street address, if any, and the name of the municipality (or city used for mailing purposes). If the form has an expiration date, it must be valid on Election Day.

Acceptable Forms of Proof of Identification A valid photo ID is not required to have a current

address.

Only one of the following is required:

A Wisconsin DOT-issued driver license, even if driving privileges are revoked or suspended

A Wisconsin DOT-issued identification card

A Military ID card issued by a U.S.

uniformed service

A U.S. passport

Identifications above must have

an expiration date after the

November 2, 2010 election.

A certificate of naturalization that was

issued not earlier than two years before the date of an election at which it is presented

An unexpired driving receipt issued by

Wisconsin DOT

An unexpired identification card receipt issued by Wisconsin DOT

An identification card issued by a federally

recognized Indian tribe in Wisconsin

An unexpired identification card issued by a Wisconsin-accredited university or college accompanied by a proof of enrollment in that university or college. The identification card must contain the following:

Date of Issuance Signature of student Expiration date not later than two years

after date of issuance

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of 232Printed 7/30/2012 10:32:26 AM -

Election: 2012 PARTISAN PRIMARY - 14 Aug 2012

District(s): WD1, WD2, WD3, WD4

The Information on this form is required by ss.6.79(1m)(4)(6), 6.82(1)(a),2(d),6.88(3)(a), Stats.

GAB-107 (SVRS 2012)

Nathaniel E. Robinson

WI_PL_ELE_POLL-LN

TOWN HALL

TOWN OF OAKLAND

Poll Book - 2012PARPRI - TOWN HALL

Certification of Administrator

I certify that the attached list is a true and complete registration list of the municipality or the ward or the wards for which the list is prepared.

Government Accountability Board Administrator, Elections Division

Election Inspector Signatures:

1.

2.

3.

4.

Total Number of Voters:

Page Number of Last Voter:

Number of Absentee Electors:

5.

6.

Total Number of Voters Printed on the Poll List: 2141

7.

Chief Inspector

Election Inspectors

We certify that the attached list contains all the names of persons voting at the election held on,

Certification

, and that it contains all the information about the electors

required by law. We further certify that this list is true, correct and complete.

August 14th, 2012

-49-

of 232Printed 7/30/2012 10:32:26 AM AAR ADS-

CG05 0896 AS33

28022-PARTISAN ADAS, Timothy John

W9477 US HIGHWAY 12WD1

CAMBRIDGE,WI 53523

728022-001-0896-1-

0000548699

Notes:

*0000548699*

CG05 2702 AS33

28022-PARTISAN ADAMSON, Donald R

N4237 COUNTY ROAD GWD3

FORT ATKINSON,WI 53538

628022-003-2702-2-

0707727010

Notes:

*0707727010*

CG05 0896 AS33

28022-PARTISAN ADLER, Jean Louise

W9147 RED FEATHER DRWD2

CAMBRIDGE,WI 53523

828022-002-0896-1-

0030026431

Notes:

*0030026431*

CG05 0896 AS33

28022-PARTISAN ADSIT, John Raymond

W9569 SKOGEN RDWD1

CAMBRIDGE,WI 535231028022-001-0896-1-

0702627110

Notes:

*0702627110*

CG05 0896 AS33

28022-PARTISAN ADSIT, Ann Louise

W9569 SKOGEN RDWD1

CAMBRIDGE,WI 53523928022-001-0896-1-

0707807960

Notes:

*0707807960*

CG05 1883 AS33

28022-PARTISAN ADAMS, Mary Ann

N2983 BLOCK LNWD4


528022-004-1883-1-

0702052960

Notes:

*0702052960*

CG05 1883 AS33

28022-PARTISAN ACHILLI, Zachary Adam

N2516 COUNTY ROAD JWD4


228022-004-1883-1-

0707666120

Notes:

*0707666120*

CG05 0896 AS33

28022-PARTISAN AARON-BENEDUM, Kris

W9423 COUNTY ROAD CWD1

CAMBRIDGE,WI 53523

128022-001-0896-1-

0007512001

Notes:

*0007512001*

CG05 0896 AS33

28022-PARTISAN ACKETZ, Mary E

N4647 PRAIRIE ROSE RDWD1

CAMBRIDGE,WI 53523

428022-001-0896-1-

0007512003

Notes:

*0007512003*

CG05 0896 AS33

28022-PARTISAN ACKETZ, Donald Francis

N4647 PRAIRIE ROSE RDWD1

CAMBRIDGE,WI 53523

328022-001-0896-1-

0007512002

Notes:

*0007512002*

Names beginning with the letter [A]

Voter SignatureBallot, Ward, District

Name and Address Voter #Voter Reg & Barcode

-50-

Certificate of Registration General Instructions: Please use uppercase (CAPITAL) letters only. Please Review Fully Form to be completed by municipal clerk. Completed form is given to Elector to give to Election Inspector at polling location. Polling Location Voting # Ward # Voter Registration #

Certificate #

STATE OF WISCONSIN

Municipality

County

To: Election Inspectors Name

This is to certify that: Street Address

City, State, ZIP + 4 Has completed the required voter registration application in the Office of the Clerk and said elector should be permitted to cast his or her vote for the election to be held on:

/ / Election Date (MM/DD/YYYY)

Subscribed to in the Office of the Clerk of: This Day of

Date Month

Municipality Name

,

Year

Signature of Clerk X GAB-133 | Rev 2006-08 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: [email protected]

Certificate of Registration Municipal Clerk’s Copy

General Instructions: Please use uppercase (CAPITAL) letters only. Please Review Fully Form to be completed by municipal clerk. Completed form is given to Elector to give to Election Inspector at polling location. Polling Location Voting # Ward # Voter Registration #

Certificate #

STATE OF WISCONSIN

Municipality

County

To: Election Inspectors Name

This is to certify that: Street Address

City, State, ZIP + 4

Has completed the required voter registration application in the Office of the Clerk and said elector should be permitted to cast his or her vote for the election to be held on:

/ / Election Date (MM/DD/YYYY)

Subscribed to in the Office of the Clerk of: This Day of

Date Month

Municipality Name

,

Year

Signature of Clerk X


Certificate of Registration Instructions

General Instructions: Please Review Fully

This form is used during the late registration period (between 20 days before the election and the day of the election) to certify that the voter is registered, since the voter’s registration information will not appear on the Poll List. This form is completed after the voter completes a valid Voter Registration Application (EB-131) and the clerk approves the application.

The municipal clerk completes this form and gives the top portion to the voter. The voter gives the form to the Election Inspectors at the polling location on election day.

Since the municipal clerk should keep a copy of the form, the bottom portion has been designed to duplicate the top portion. The municipal clerk may also copy the completed form or use pressure-sensitive or carbon paper to allow for a duplicate to be completed.

1 Polling location: Complete the proper polling location.

2 Ward #: Complete the proper ward number.

3 Voting #: Official Use Only. Voter # is completed by the Election Inspectors at the polling location when voter presents the form to them.

4 Voter Registration #: Office Use only. The unique number given to a voter in SVRS. This is used when information is entered into SVRS at time of late registration.

5 Certificate #: The serial number issued by the municipal clerk when filing a late registration, i.e. starting with #1, #2, #3 and so forth. The clerk’s agent (provider) issues a serial number followed by “c,” i.e. #1c, #2c, #3c and so forth.

6 Municipality: Complete name of municipality.

7 County: Complete name of county in which municipality is located.

8 Name, Address, City: Complete name and voting address of voter.

9 Election Date: Complete the date of the primary or election event.

10 Municipality Name: Complete the name of the municipality.

11 Date: Complete the date completed.

Signature: By signing this form, the municipal clerk certifies that the elector has completed the voter registration application and directs the Election Inspectors to permit the elector to vote for the election to held on the date indicated on the form.


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Application For Presidential Ballot - New Wisconsin Resident For Presidential Election to be held on November ____, ______. (check one): To the Clerk of , Town State of Wisconsin. Village City I, , do solemnly swear that: 1. I am a citizen of the United States, and before establishing my present residence in Wisconsin, my legal

residence was at: (check one):

Town (former street address) Village (former state) City 2. On the day of the next Presidential Election, I will be at least 18 years of age, and I have been a legal

resident of the State of Wisconsin at the following address since the date indicated: (check one):

Town (date established residency)

Village (present street address) City (present municipality and county)

3. I am qualified to vote for President and Vice President at the election to be held on November ____, ____ . 4. I have resided in Wisconsin for less than 28 days, and I am not voting at any other place in this election. I request an Official Presidential Ballot, in accordance with Wis. Stat. § 6.15. Signature of applicant __________________________________________________________________ Residence address _____________________________________________________________________ City _____________________________________, State ________________________ Zip ___________ State of Wisconsin ) ) ss. County of ) Subscribed and sworn to before me this ________day of _________________________, ______. _________________________________________________

(signature of municipal or deputy clerk or election inspector) Penalties for Violation. Whoever swears falsely to any absent elector affidavit under Wis. Stat. § 6.15, may be fined not more than $1,000 or imprisoned not more than 6 months, or both. Whoever intentionally votes more than once in an election may be fined not more than $10,000 or imprisoned not more than 4 years and 6 months, or both. GAB-141 (Rev.7/2012) The information on this form is required by Wis. Stat. § 6.15. -53-

INSTRUCTIONS FOR APPLICATION FOR PRESIDENTIAL BALLOT - NEW WISCONSIN RESIDENT

Any person who is a United States citizen, at least 18 years old on election day, who has moved into the State of Wisconsin less than 28 days before the presidential election, and is ineligible to vote absentee in his or her state of previous residence, may vote for president and vice president by completing this application and providing a valid proof of residence. If voter registration is required, a new Wisconsin resident making application for a presidential ballot need not be registered. A new Wisconsin resident can complete this application and vote for president and vice president either by absentee ballot in the office of the municipal clerk, or by voting at the polling place on election day. In addition to completing this application form (GAB-141) and providing a valid proof of residence, the elector also must complete a voter registration cancellation card (GAB-139). Both of these items are provided by the municipal clerk. They also can be obtained from an election inspector at the polling place on election day.

PROCEDURE FOR MAKING APPLICATION IN THE MUNICIPAL CLERK'S OFFICE 1. The new Wisconsin resident shows a valid proof of residence, completes the application form (GAB-141),

and the voter registration cancellation card (GAB-139).

2. If the new Wisconsin resident chooses to vote an absentee presidential ballot in the clerk's office, the municipal clerk provides the person with an absentee ballot certificate envelope (GAB-122) and a presidential ballot. The clerk must keep a list which includes the name, address, date of application, and the date on which the ballot was cast.

3. If the new Wisconsin resident making this application chooses to go to the polling place on election day to

vote, the municipal clerk must provide the person with a copy of the completed application form (GAB-141) to take to the polling place.

4. The municipal clerk must keep a separate list of all new Wisconsin residents who vote under the provisions

of Wis. Stat. § 6.15. The list must include the person's name, address, and date of application, and if voting by absentee ballot, the date of receipt of the voted ballot.

5. The municipal clerk shall send the voter registration cancellation card (GAB-139) to the elector's

municipality of previous residence.

PROCEDURE FOR VOTING FOR PRESIDENT AT THE POLLING PLACE 1. The new Wisconsin resident can show a valid proof of residence, complete this application (GAB-141), and

the voter registration cancellation card (GAB-139) at the polling place, or bring a copy of the application form that was completed in the municipal clerk's office.

2. The election inspector will provide the person with a paper ballot to vote for the offices of president and

vice president only. 3. The election inspectors shall indicate on the voter list next to the new Wisconsin resident's name that he or

she received only a presidential ballot. 4. The application form (GAB-141) and the voter registration cancellation card (GAB-139) are returned to the

municipal clerk along with the voter lists and other election documents.

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Wisconsin Voter Registration Application Submitted by Mail (Official Use Only)

Confidential Elector ID# (HINDI - sequential #) (Official Use Only) SVRS ID #

(Official Use Only)

Instru

ctio

ns

Instructions for completion are on the back of this form. Return this form to your municipal clerk, unless directed otherwise.

Please use uppercase (CAPITAL) letters only. Fill in circles as appropriate.

If you have not previously voted in WI and are submitting this form by mail, you must also provide a copy of your proof of residence (see reverse).

NOTE: If this is a change of address, then upon completion of this application your voting rights will be cancelled at your previous residence.

1 New WI Voter

Name Change

Address Change

Municipality Town

Village City

County

2

WI Driver License or WI DOT-issued ID (DL # required if issued)

Expiration Date I have neither a WI Driver License/ ID nor a Social Security Number.

Social Security Number - Last Four Digits (if driver license not issued or not current and valid)

X X X - X X -

3

Last Name First Name

Curre

nt

Middle Name Suffix (e.g. Jr, II, etc.) Phone #

Date of Birth (M/D/YYYY) Email Address

If you are a military or permanent overseas elector, fill in the appropriate circle (see instructions for definitions): Military Permanent Overseas

4 Residence Address: Street Number & Name

Apt. Number City State & ZIP

5 Mailing Address: Street Number & Name


6 Pre

vio

us

Last Name First Name

Middle Name Suffix (e.g. Jr, II, etc.)

7

Previous Address: Street Number & Name


8

Accommodation needed at poll location (e.g. wheelchair access):

If you do not have a street number or address, use the map to show where you live.

Mark crossroads

‘X’ where you live

Use dots for landmarks I am interested in being a poll worker.

9

Please answer the following questions by filling in “Yes” or No”: 1. Are you a citizen of the United States of America? 2. Will you be 18 years of age or older on or before election day?

Yes No

Yes No

If you filled in “No” in response to EITHER of these questions, do not complete this form.

10

I hereby certify, to the best of my knowledge, that I am a qualified elector, a U.S. citizen, at least 18 years old or will be at least 18 years old at the time of the next election, having resided at the above residential address for at least 28 consecutive days immediately preceding this election, with no present intent to move. I am not currently serving a sentence including incarceration, parole, probation, or extended supervision for a felony conviction, and not otherwise disqualified from voting. I certify that all statements on this form are true and correct. If I have provided false information I may be subject to fine or imprisonment under State and Federal laws. If completed on Election Day: I further certify that I have not voted in this election. Please sign below to acknowledge that you have read and understand the above.

11

Signature of Elector X

Today’s Date (M/D/

YYYY)

Election Day Voter # (Official use only)

Falsification of information on this form is punishable under Wisconsin law as a Class I felony.

12

Assistant Signature: Assistant Address: Proof of Residence type (Official use only)

Proof of Residence # (Official use only)

Official’s Signature: SRDs printed name and SRD#:

Ward Sch. Dist. Alder Cty. Supr. Ct. of App. Assembly St. Senate Congress

GAB-131 (REV 6/2012)

Example

Woodchuck Road

High School

Library

X

N

-55-

These documents constitute proof of residence if they:

Contain the voter’s current and complete first and last name and residential address, and

are valid on the day used to register to vote.

A current and valid WI Driver License / ID Card Any other official identification card or license issued by a Wisconsin governmental body or unit

An employee ID card with a photograph, but not a business card

A real property tax bill or receipt for the current year or the year preceding the date of the election

A residential lease (Does not count as proof of residence if elector submits form by mail)

A picture ID from a university, college or technical college coupled with a fee receipt

A picture ID from a university, college or technical college coupled with an on-campus housing listing provided by the university, college or technical college to the municipality that denotes US Citizenship

A utility bill for the period commencing not earlier than 90 days before the day registration is made

(Homeless voters only) A letter from an organization that provides services to the homeless that identifies the voter and describes the location designated as the person’s residence for voting purposes

A bank statement A paycheck A check or other document issued by a unit of government

Wisconsin Voter Registration Application Instructions Each section on the front side of this document corresponds to the sections below (1-12)

1

Fill in the circle (New WI Voter, Name Change, Address Change) describing why you are completing this form. A “New WI Voter” is anyone who is not currently registered to vote in Wisconsin. You can check your voter registration

status at Wisconsin’s Voter Public Access website (https://vpa.wi.gov) Indicate your county and municipality of residence (e.g. Village of Cambridge, Dane County).

2

If you have been issued a WI driver license and it is current and valid, you must provide the number and expiration date.

If you have been issued a WI driver license or WI DOT-issued ID and it is currently revoked, suspended, or expired, please provide the number and the last 4 digits of your Social Security number.

If you have not been issued a WI driver license, you must provide either your WI DOT-issued ID number or the last 4 digits of your Social Security number.

If you do not have a WI driver license, a WI DOT-issued ID, or a Social Security number, indicate that fact by filling in the appropriate circle.

If you are registering to vote on Election Day and have been issued a WI driver license, but are unable or unwilling to provide the number, your vote will not be counted unless you provide the number to the election inspectors by 8:00 p.m. on Election Day or to your municipal clerk by 4:00 p.m. the Friday following Election Day.

3

Provide your current and complete name including your last name, first name, middle name or initial, and suffix (Jr, Sr, etc), if any. Please verify you have provided your name as it appears on the document, the number of which you provided in Box 2, if that document is still your current and complete name.

Provide your month, day and year of birth. Providing your phone number and/or email address is optional and is subject to open records requests. A “military elector” is a person, or the spouse or dependent of a person who is a member of a uniformed service or

merchant marine, a civilian officially attached to a uniformed service and serving outside the United States, or a Peace Corp volunteer. Military electors are not required to register as a prerequisite to voting at any election.

A “permanent overseas elector” is a US citizen, at least 18 years old, who does not qualify as a resident of this state, but who was last domiciled in this state or whose parent was last domiciled in this state immediately prior to the parent’s departure from the United States, and who is not registered to vote in any other state.

4

Provide your home address (legal voting residence) in Wisconsin. Provide your full street name, including the type (St, Ave, etc) and any pre- and/or post-directional (N, S, etc.). Provide the city name and zip that appears on mail delivered to your home address. You may not enter a PO Box as a residential address. A rural route box without a number should not be used.

5 If your mailing address is different from your home address, provide it here. A PO Box is acceptable as a mailing

address. Overseas electors should provide their complete overseas address here.

6 Provide your previous first, last and middle names, along with a suffix, if any.

7 Provide the most recent address where you were previously registered to vote, if any.

8 If you need assistance when voting, you may describe the assistance required (e.g. curbside voting, braille materials). If you are interested in being a poll worker for your municipality, you may fill in the circle to indicate your interest. If you do not have a street address, use the map to show where you live.

9

If you answer “No” to either question in this section, you are not eligible to vote in Wisconsin. Please note, for question 2, you must either be at least 18 years old, or will be at least 18 years old at the time of the next election to be eligible to vote. If you are completing on election day you must be 18 years old today.

12 Assistant: If you are unable to sign this form due to a physical disability, you may have an assistant do so on your

behalf. That assistant must provide his or her signature and address in the space provided. By signing, the assistant certifies that he or she signed the form at your request.

-56-

https://vpa.wi.gov

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