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<br />( <br /> <br />ABSENTEE BALLOT AFFIDAVIT <br />Section 101.69, F.S. <br /> <br />This affidavit is to be filled out by a voter who was issued an absentee ballot, is <br />requesting to vote in person and does not have the absentee ballot to turn in at the polls. <br /> <br />I, <br /> <br />do hereby swear (or affum) that <br /> <br />(print Name) <br /> <br />I have not voted by absentee ballot for the <br /> <br />election. <br /> <br />(election) <br /> <br />( <br /> <br />I understand that anyone who votes both in person and by absentee ballot at any <br />election is in violation ofs. 104.17, F.S., and can be convicted ofa felony of the third <br />degree and fined up to $5,000 and/or imprisoned for up to five years. <br /> <br />Under penalties of peIjury, I declare that I have read the foregoing affidavit and that <br />the facts stated in it are true. <br /> <br />Signature of Voter <br /> <br />Date <br /> <br />Precinct <br /> <br />. Residence Address <br /> <br />Voter ID <br /> <br />City t State, Zip <br /> <br />Witness: Member of Election Board <br /> <br />{ <br /> <br />3.29 <br />