2019 Arkansas Code Title 7 - Elections Chapter 5 - Election Procedure Generally Subchapter 3 - Conduct of Elections § 7-5-312. Challenge of Voter's Ballot by Poll Watchers, Candidates, or Designees Form 1
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“POLL WATCHER AUTHORIZATION FORM
Representative of a Candidate
I, ............................, state that I am a candidate for the office of
............................ in the ............................ election. I
further state that I have designated ............................ as my
authorized representative at the election at polling sites
............................ and absentee ballot processing sites
............................ in ............................ County,
Arkansas, to observe and ascertain the identity of persons presenting
themselves to vote in person or by absentee for the purpose of
challenging any voter in accordance with Arkansas Code §§ 7-5-312,
7-5-416, and 7-5-417. I further state that I have designated and
authorized my representative named above to be present at the
ballot counting locations at ................................................................
in ............................ County, Arkansas, for the purpose of
witnessing the counting of ballots by election officials and determining
whether ballots are fairly and accurately counted in accordance with
Arkansas Code §§ 7-5-312, 7-5-316, 7-5-413, 7-5-416, 7-5-527, and
7-5-615.
Representative of a Group
I, ............................, state that I represent the
............................ group that is seeking passage/defeat (circle
one) of the ballot measure entitled ............................ on the
ballot in the ............................ election at polling sites
............................ and absentee ballot processing sites
............................ in ............................ County,
Arkansas, to observe and ascertain the identity of persons presenting
themselves to vote in person or by absentee for the purpose of
challenging any voter in accordance with Arkansas Code §§ 7-5-312,
7-5-416, and 7-5-417.
Representative of a Party
I, ............................, state that I am the chair or secretary of the
state/county (circle one) committee for the ............................
party with candidates on the ballot in the ............................
election. I further state that I have designated
............................ as an authorized party representative at the
election at polling sites ............................ and absentee ballot
processing sites ............................ in .................................................
County, Arkansas, to observe and ascertain the identity of persons
presenting themselves to vote in person or by absentee for the
purpose of challenging any voter in accordance with Arkansas
Code §§ 7-5-312, 7-5-416, and 7-5-417. I further state that I have
designated and authorized my representative named above to be
present at the ballot counting locations at ..........................................
in ............................ County, Arkansas, for the purpose of
witnessing the counting of ballots by election officials and
determining whether ballots are fairly and accurately counted in
accordance with Arkansas Code §§ 7-5-312, 7-5-316, 7-5-413,
7-5-416, 7-5-527, and 7-5-615.
................................................
Signature of Candidate, Group Representative, or Chair/Secretary of the
State/County Committee
Acknowledged before me this .............. day of .............., 20......
Notary Public: ............................
My Commission Expires: ..............
I do hereby state that I am familiar with the rights and responsibilities of
a poll watcher as outlined on the back of the poll watcher authorization
form and will in good faith comply with the provisions of same.
................................................
Signature of the Poll Watcher
Acknowledged before me this .............. day of .............., 20......
Notary Public: ............................
My Commission Expires: ..............
I do hereby acknowledge the filing of this poll watcher authorization
form with the county clerk’s office.
................................................
Signature of County Clerk”.
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