(a) When and where declared competent by a court: 10. (a) If you have a current driver's license, state its number and the address shown thereon: (b) If you own a motor vehicle, state license tag number and the county and State in which the vehicle is registered for ad valorem and road and bridge privilege tax purposes: (c) If you filed an income tax return for the year immediately past, state the address on your most recent income tax return: (d) If you own real property, state its location: (e) If you are receiving homestead exemption on any real property, state the location of all such property: (f) If you are currently employed, state the location of the place where you actually report for work: (g) State the location of any church affiliation or location of any other religious groups of which you are a member: (h) State the location of the greater amount of your personal possessions: (1) If you have a telephone, state its location and number: 11. Do you intend to make this precinct and county your fixed habitation, for a definite or indefinite length of time, to which you intend to return whenever absent? O Yes No Any willful false statement on this application is a Federal crime punishable by fine or imprisonment. STOP HERE. TAKE THE FORM TO THE EXAMINER I do solemnly swear (or affirm) that I am at least eighteen (18) years old (or will be before the next election in this county), and that I am now in good faith a resident of this state and of election pre cinct in this county and that I am not disqualified from voting by reason of having been convicted of any crime named in the Constitution of this state as a disqualification to be an elector; that I have truly answered all questions propounded to me in the foregoing application for registration; and that I will faithfully support the Constitution of the United States and of the State of Mississippi, and will bear true faith and allegiance to the same. So help me God. Signature (or mark) of applicant Sworn to (or affirmed) and subscribed before me this date Examiner U.S. Office of Personnel Management Certificate of Eligibility Issued-No. Notice of Ineligibility Issued-No. CSC Form 805-M Revised February 1973 Back Do not write on this side-for use by examiner ADDITIONAL INFORMATION ITEMS 2. If applicant shows his age to be under 21, will he be 21 by the date of the next election? O Yes No Write in his date of birth 5. If applicant shows that he has not lived in Mississippi for two years, will he have lived in Mississippi for two years by the date of the next election? Yes No If yes, write in the date residence began Former address 6. If applicant shows that he has not lived at his present address one year, will he by the date of the next election have: 6. How long have you lived at the above address 7. What is your ward and precinct 8. Are you now (1) a student, (2) a seaman, (3) an employee of the United States, or (4) on active duty in the Armed Forces of the United States Yes No 9. (a) Are you now registered to vote in South Carolina Yes No (b) Are you now listed under the Voting Rights Act Yes No 10. Are you a citizen of the United States and the State of South Carolina Yes No 11. Have you ever been convicted of a crime other than a traffic violation Yes No 12. Have you ever been declared legally insane, idiotic, or mentally incompetent by a court Yes No 13. Are you a pauper receiving all your support from your county, town, or city government DYes ONO Any willful false statement on this application is a Federal crime punishable by fine or imprisonment STOP HERE-TAKE THE FORM TO THE I hereby solemnly swear (or affirm) that the information I have provided is true to the best of my knowledge and belief and I so certify. Signature (or mark) of applicant O Yes No If so pardoned, where, when and by whom 12. If the applicant shows that he has been declared legally insane, idiotic, or mentally incompetent by a court, has he subsequently been declared legally sane or mentally competent by a court ☐ Yes ☐ No If yes, when and by what court 13. If the applicant shows that he is a pauper receiving all of his support from his county, town, or city, write details here Certificate of eligibility issued-No. Notice of ineligibility issued-No. TEXAS Front Form approved OMB No. 50R0592 Voting Rights Act Application The information requested below is for the purpose of determining whether you are eligible to vote. If you are found eligible to vote, your name will be certified to appropriate state officials for addition to the official voting lists. The solicitation of this information for this purpose is authorized by the Voting Rights Act of 1965, as amended. While you are not required to respond, your cooperation is needed if you wish to be found eligible to vote. Instructions to the Applicant: Please fill out this side of this form. If you need help in answering any question, the Examiner will help you. tion or its location: 8. Former registration: If now registered in another Texas County: (Name of county) Last residence address: (Street and apt. No., if any) (State) (City) (ZIP Code) The disclosure of social security number and telephone number is voluntary. Failure to state either or both numbers will NOT result in your application being deficient. The numbers will be used only to maintain the accuracy and integrity of the registration records. Social Security Number phone Number Tele TAKE THE FORM TO THE EXAMINER. I do solemnly swear (or affirm) that I, the applicant, am 18 years of age or over, or will be 18 years of age or older within 60 days after applying for registration, and am a citizen of the United States, hold legal residence in this county, have met all legal requirements, and I understand that the giving of false information to procure the registration of a voter is a felony. Signature (or mark) of applicant *Agent must be a registered voter, and must be only: (Circle one applicable) Husband-Wife-Mother-Father-Son-Daugh ter Sworn to (or affirmed) and subscribed to me this date Examiner U.S. Office of Personnel Management Back Do not write on this side-For use by examiner Additional Information Items Texas law states that a person convicted of a felony and not subsequently pardoned, and a person adjudicated a lunatic or idiot and not subsequently adjudicated competent, are not qualified to vote. Therefore, the following questions must be asked. A. Have you ever been convicted of a felony: Yes No If applicant answers yes, name the crime Was the conviction for a disqualifying crime: Yes No If a disqualifying crime, has applicant been pardoned with restoration of his right to vote: O Yes No If so pardoned, how and when B. Have you ever been declared to be an idiot or a lunatic by a court: ☐ Yes ☐ No If applicant answers yes, has he subsequently been declared legally sane or competent by a court: O Yes No If yes, when and by what court (5 U.S.C. 1103; Secs. 7, 9, 79 Stat. 440, 411, 441 (42 U.S.C. 1973c, 1973g)) [30 FR 9859, Aug. 7, 1965] EDITORIAL NOTE: For FEDERAL REGISTER Citations affecting this appendix A, see the List of CFR Sections Affected in the Finding Aids section of this volume. APPENDIX B TO PART 801 This appendix sets out the qualifications required for listing on an eligibility list. ALABAMA A person is qualified to be listed as an eligible voter in elections in the State of Alabama, except municipal elections, if he has all the following qualifications at the time he applies for listing and if he takes the required oath or affirmation. (1) He is 21 years of age. (2) He is a citizen of the United States and of the State of Alabama. (3) He will have lived in the State of Alabama for one year, in his county for six months, and in his ward or precinct for three months by the date of the next election. (4) He has not been convicted of treason, murder, arson, embezzlement, malfeasance in office, larceny, receiving stolen property, obtaining property or money under false pretenses, perjury, subornation of perjury, robbery, assault with intent to rob, burglary, forgery, bribery, assault and battery on the wife, bigamy, living in adultery, sodomy, in cest, rape, crime against nature, or any crime punishable by imprisonment in the penitentiary, or of any infamous crime or crime involving moral turpitude, or of vagrancy or being a tramp, or of selling or offering to sell his vote or the vote of another, or of buying or offering to buy the vote of another, or of making or offering to make a false return in any election by the people or in any primary election to procure the nomination or election of any person to any office, or of suborning any witness or registrar to secure the registration of any person as an elector, or if so convicted he has been subsequently pardoned with restoration of his right to vote specifically expressed in the pardon. (5) He has not been declared legally insane by a court, or if so declared he has subsequently been declared legally sane or competent by a court. (6) He is not otherwise registered or listed as eligible to vote in the county in which he applies for listing. A person who has all the above qualifications is also qualified to be listed as an eligible voter in municipal elections if he will have lived in his city or town for three months by the date of the next election. GEORGIA A person is qualified to be listed as an eligible voter in elections in the State of Georgia, except municipal elections, if he has all the following qualifications at the time he applies for listing and if he takes the required oath or affirmation. (1) He will be 18 years of age by the date of the next election. (2) He is a citizen of the United States and of the State of Georgia. (3) He will have lived in the State of Georgia for 1 year and in his county for 6 months by the date of the next election. (4) He has not been convicted of treason against the State, embezzlement of public funds, malfeasance in office, bribery or larceny, or of any crime involving moral turpitude, punishable by the laws of Georgia with imprisonment in the penitentiary, or if so convicted he has been subsequently pardoned. (5) He has not been declared legally insane or idiotic by a court, or if so declared he has been subsequently declared legally sane or competent by a court. (6) He is not otherwise registered or listed as eligible to vote in the county in which he applies for listing. LOUISIANA A person is qualified to be listed as an eligible voter in elections in the State of Louisiana, except municipal elections, if he has all the following qualifications at the time he applies for listing and if he takes the required oath or affirmation. (1) He will be 21 years of age by the date of the next election. (2) He is a citizen of the United States and of the State of Louisiana. (3) He will have lived in the State of Louisiana for one year, in his parish for six months, and in his precinct for three months by the date of the next election. (4)(a) He has not been convicted of any crime punishable by imprisonment in the penitentiary, or if so convicted he has been subsequently pardoned with the express restoration of the franchise, or (b) he has not been convicted of a felony, or if so convicted he has subsequently received a pardon and full restoration of franchise. (5) He has not been interdicted, that is, declared legally incompetent or insane by a court, or if so interdicted he has been subsequently restored to legal competency or sanity by a court. (6) He has not been dishonorably discharged from the Louisiana National Guard or the military service of the United States, or if so discharged he has been reinstated. (7) He is not a deserter from the military services of the United States or the militia of the State of Louisiana, when called forth by the Governor or, in time of invasion, insurrection, or rebellion, by the President of the United States, or if such a deserter, he has returned to the command from which he deserted, made good the time lost in desertion, and served out the term of his original enlistment. (8) He is not an inmate of any charitable institution, except the Soldiers Home and the United States Marine hospital at Carville. (9) He is not otherwise registered or listed as eligible to vote in the parish in which he applies for listing. A person who has all the above qualifications is qualified to be listed as an eligible voter in municipal elections if he will have lived in his city or town for four months by the date of the next election. MISSISSIPPI A person is qualified to be listed as an eligible voter in elections in the State of Mississippi, except municipal elections, if he has all the following qualifications at the time he applies for listing and takes the required oath or affirmation. (1) He will be 21 years of age by the date of the next election. (2) He is a citizen of the United States. (3) He will have lived in the State of Mississippi for two years by the date of the next election. (4) He will have lived in his election district or his city, town, village, or municipality for one year by the date of the next election. However, if the person is a minister or the wife of a minister of the Gospel in charge of an organized church, that person is qualified if he or she will have lived in the election district for six months by the date of the next election. (5) He has not been convicted of arson, bigamy, bribery, burglary, embezzlement, forgery, obtaining money or goods under false pretenses, perjury, or theft, or if so convicted his right to vote has been restored by the legislature. (6) He has not been declared legally insane by a court, or if so declared he has been subsequently declared legally sane or competent by a court. (7) He is not otherwise registered or listed as eligible to vote in the county in which he applies for listing. A person who has all the above qualifications is qualified to be listed as an eligible voter in municipal elections if he will have lived in his city, town, or village for one year by the date of the next election, unless he has, within two years before the next municipal election, been convicted within the municipality of violating the liquor laws of the State or the municipality. However, if the person is a minister or the wife of a minister of the Gospel in charge of an organized church, that person is qualified to be listed as an eligible voter in municipal elections if he or she will have lived in the city, town, or village for six months by the date of the next election. SOUTH CAROLINA A person is qualified to be listed as an eligible voter in elections in the State of South Carolina, except municipal elections, if he has all the following qualifications at the time he applies for listing and if he takes the required oath or affirmation. (1) He is 21 years of age. (2) He is a citizen of the United States and of the State of South Carolina. (3) He will have lived in the State of South Carolina for one year, in his county for six months, and in his precinct for three months by the date of the next election. However, if the person is a minister in charge of an organized church or a teacher in the public schools, or the spouse of such a minister or teacher, that person is qualified if he or she will have lived in the State of South Carolina for six months by the date of the next election. (4) He has not been convicted of burglary, arson, obtaining goods or money under false pretenses, perjury, forgery, robbery, bribery, adultery, bigamy, wife-beating, housebreaking, receiving stolen goods, breach of trust with fraudulent intent, fornication, sodomy, incest, assault with intent to ravish, larceny, challenging or accepting a challenge to duel with a deadly weapon, or crimes against the election laws, or if so convicted his right to vote has been restored by pardon. |