2009 Rhode Island Code
Title 17 - Elections
CHAPTER 17-20 - Mail Ballots
§ 17-20-21 - Certifying envelopes.

SECTION 17-20-21

   § 17-20-21  Certifying envelopes. – The secretary of state shall cause to be prepared and printed and shall furnish with each mail ballot an envelope for sealing up and certifying the ballot when returned. The envelope shall be printed in substantially the following form:

   "After marking ballot or ballots, fold and enclose in this envelope and seal it. Certify to statement hereon. Enclose in envelope addressed to board of elections, which must receive the envelope not later than nine o'clock (9:00) p.m. the day of election."

   Date of Election:]]]]]]]]]]]]]] City/Town of:]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

   Certificate of Voter

   I certify under penalty of perjury

   Print Name of Voter

   that I am a resident of the state of Rhode Island and a qualified voter of the state residing at

   (Street and number, if any)

   in the city or town of ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] and that I am eligible to cast a mail ballot for the reason set forth in my application and that I have not qualified to vote elsewhere than as set forth on this envelope, nor do I intend to vote for any of the candidates, amendments or propositions named in the enclosed ballot elsewhere or in any other manner.

   Voter must sign full name here:

   (If unable to sign name because of physical incapacity or otherwise, voter shall make his or her mark "(X)").

   Before me the ]]]]]]]]]]]]] day of ]]]]]]]]]]]]]] 20]]]]]]]], at ]]]]]]]]]]]]]]]] (city or town), county of ]]]]]]]]]]]]]]]], state of ]]]]]]]]]]]]]]]]]]]], personally appeared the above named voter, to me known and known by me to be the person who affixed his or her signature to this ballot envelope.

   ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

   Notary Public            &n bsp;        

   Notary must also print his or her name

   Witness:

   ]]]]]]]]]]]]]]]]]]]]]]]]]]

   (Signature) (Residence)

   Note: Mail ballots must either be sworn to before a notary public or before two (2) witnesses who must sign their names and addresses. If the voter is incapacitated because of illness, mental or physical disability, blindness or a serious mobility impairment and checked subdivision (3) on the mail ballot application, no notarization or witnesses are necessary.