Nevada Code § 293.3082

Casting of provisional ballot: Specific prerequisites; completion of written affirmation; contents of affirmation; provision of receipt; notation on roster
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1. Before a person may cast a provisional
ballot pursuant to NRS 293.3081 , the
person must complete a written affirmation on a form provided by an election
board officer, as prescribed by the Secretary of State, at the polling place
which includes:
(a) The name of the person casting the
provisional ballot;
(b) The reason for casting the provisional
ballot;
(c) A statement in which the person casting the
provisional ballot affirms under penalty of perjury that he or she is a
registered voter in the jurisdiction and is eligible to vote in the election;
(d) The date and type of election;
(e) The signature of the person casting the
provisional ballot;
(f) The signature of the election board officer;
(g) A unique affirmation identification number
assigned to the person casting the provisional ballot;
(h) If the person is casting the provisional
ballot pursuant to subsection 1 of NRS
293.3081 :
(1) An indication by the person as to
whether or not he or she provided the required identification at the time the
person applied to register to vote;
(2) The address of the person as listed on
the application to register to vote;
(3) Information concerning the place,
manner and approximate date on which the person applied to register to vote;
(4) Any other information that the person
believes may be useful in verifying that the person has registered to vote; and
(5) A statement informing the voter that
if the voter does not provide identification at the time the voter casts the
provisional ballot, the required identification must be provided to the county
or city clerk not later than 5 p.m. on the Friday following election day and
that failure to do so will result in the provisional ballot not being counted;
(i) If the person is casting the provisional
ballot pursuant to subsection 2 of NRS
293.3081 :
(1) The address of the person as listed on
the application to register to vote;
(2) The voter registration number, if any,
issued to the person; and
(3) A statement informing the voter that
the required identification must be provided to the county or city clerk not
later than 5 p.m. on the Friday following election day and that failure to do
so will result in the provisional ballot not being counted; and
(j) If the person is casting the provisional
ballot pursuant to subsection 3 of NRS
293.3081 , the voter registration number, if any, issued to the person.
2. After a person completes a written
affirmation pursuant to subsection 1:
(a) The election board officer shall provide the
person with a receipt that includes the unique affirmation identification
number described in subsection 1 and that explains how the person may use the
free access system established pursuant to NRS
293.3086 to ascertain whether the persons vote was counted, and, if the
vote was not counted, the reason why the vote was not counted;
(b) The voters name and applicable information
must be entered into the roster in a manner which indicates that the voter cast
a provisional ballot; and
(c) The election board officer shall issue a
provisional ballot to the person to vote.

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