§ 2555. Provisional ballot envelopes The clerk shall deliver to each polling place on the date of the election a sufficient number of provisional ballot envelopes printed with a voter attestation. The attestation shall include: (1) A statement informing the applicant of the requirements for voter eligibility set forth in section 2121 of this title and space for the provisional voter to provide the information necessary for the town clerk to determine eligibility, including a place for the applicant to swear or affirm, by checking the appropriate box, that he or she meets all voter eligibility requirements set forth in section 2121 of this title and the signature of the provisional voter signed under penalty of perjury. In addition, the attestation shall include the following information: (A) The provisional voter’s place and date of birth. (B) The provisional voter’s town of legal residence. (C) The provisional voter’s street address or a description of the physical location of the applicant’s residence. The description must contain sufficient information so that the town clerk can determine whether the applicant is a resident of the town. (2) An attestation by the provisional voter that he or she submitted a properly completed voter application form. The attestation shall be signed by the provisional voter under penalty of perjury. (3) Space on the application for documentation of the town clerk’s action. (4) A statement informing the provisional voter: “If you choose to vote by provisional ballot, after the close of the polls, the town clerk will determine whether you meet all eligibility requirements. If the clerk denies your application, he or she will inform you that the application has been denied.”
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