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<br />f <br />'( <br /> <br />4 ,- <br />'^ <br /> <br />(( <br /> <br />~ <br /> <br />EXHIBIT V <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 tmn in at the polls. <br /> <br />I, <br /> <br />do hereby swear (or affmn) that <br /> <br />(print Name) <br /> <br />I have not voted by absentee ballot for the <br /> <br />election. <br /> <br />(election) <br /> <br />I understand that anyone who votes both in person and by absentee ballot at any <br />election is in violation of s. 104.17. F .S.. and can be convicted of a felony of the third <br />degree and~fined up to $5.000 and/or imprisoned for up to five years. <br /> <br />. , <br />Under penalties of perjury. 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, State, Zip <br /> <br />..:;'- <br /> <br />Witness: Member of ElectioD Board <br /> <br />. .. <br /> <br />. . <br />. . <br /> <br />~ <br /> <br />-:.' ..... <br />