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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.

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Last residence address: (Street and apt. No., if any) (State) 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

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, 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

Signature of agent*

*Agent must be a registered voter, and must be only: (Circle one applicable) Husband-Wife-Mother-Father-Son

Daughter

Sworn to (or affirmed) and subscribed to me this date Examiner

U.S. Office of Personnel Management
CSC FORM 805-T
April 1976

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 crimeWhere and when convicted

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Certificate of eligibility issued-No.
Notice of ineligibility issued-No.

NOTE: For FEDERAL REGISTER citations affecting this Appendix A, see the List of CFR Sections Affected in the Finding Aids section of this volume.

§ 801.203 Procedures for filing application.

(a) An applicant may obtain an application at the place and during the times set out in Appendix A for the appropriate political subdivision. An application may be completed only at the place where it was obtained and shall be submitted by the applicant in person to an examiner at that place.

(b) An examiner shall review the application in the presence of the applicant to insure that all questions are answered clearly and completely. If all questions are not answered clearly and completely or if an applicant is not able personally to complete the application in whole or in part because of lack of literacy or otherwise, or has difficulty in doing so, an examiner shall orally examine the applicant and record the pertinent information on the application or otherwise assist the applicant in completing the application.

(c) After an application is completed, an examiner shall require the applicant to take the oath or affirmation prescribed on the application and to sign his name or make his mark there

on.

§ 801.204 Qualifications requirements.

The qualifications required for listing, prescribed by the OPM after consultation with the Attorney General, for use by an examiner in examining

an applicant for listing on an eligibility list shall be set out in Appendix B to this part and incorporated in and made a part of this section.

APPENDIX B

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, incest, 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, in

surrection, 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.

(5) He has not been declared legally insane, idiotic, or incompetent by a court, or if so declared he has subsequently been declared legally sane or competent by a court. (6) He is not a pauper supported at public expense.

(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 also 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.

TEXAS

A person is qualified to be listed as an eligible voter in elections in the State of Texas 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 within 60 days after applying for registration.

(2) He is a citizen of the United States. (3) He is a resident of the State of Texas. (4) He has not been convicted of a felony, or if so convicted, he has been subsequently

restored to full citizenship and suffrage or pardoned.

(5) He has not been declared an idiot or a lunatic 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.

NOTE: For FEDERAL REGISTER Citations affecting this Appendix B, see the List of CFR Sections Affected in the Finding Aids section of this volume.

§ 801.205 Action on the application.

At the time of filing the application and in the presence of the applicant, the examiner shall review the application and make such examination as is necessary to determine whether the applicant has the prescribed qualifications. If the applicant has the prescribed qualifications, the examiner shall give him a certificate, on the form prescribed by the OPM, evidencing his eligibility to vote and enter his name on an eligibility list, the form for which is prescribed by the OPM. If the applicant does not have the prescribed qualifications, the examiner shall give him a notice of ineligibility for listing, on the form prescribed by the OPM.

§ 801.206 Review of notice of ineligibility for listing.

An applicant may obtain a review of a notice of ineligibility for listing by executing the request for review contained on that notice and returning it to the examiner or by filing a written request, either personally or through a representative, with the Examiner (State Supervisor), U.S. Office of Personnel Management, in the State involved at the address set out in Appendix C to this part and incorporated in and made a part of this section. The request shall be submitted within 10 days from the date of the notice of ineligibility for listing. The request shall set forth the applicant's reason for contesting the notice of ineligibility for listing. The Examiner (State Supervisor) shall notify the applicant or his representative and the examiner concerned of his decision. When the Examiner (State Supervisor) finds the applicant has the prescribed qualifications, he shall direct the examiner

concerned to give the applicant a certificate evidencing his eligibility to vote and to enter his name on the eligibility list. There is no administrative appeal from the decision of an Examiner (State Supervisor).

APPENDIX C

These are the addresses of each Examiner (State Supervisor), U.S. Office of Personnel Management.

ALABAMA

Examiner (State Supervisor), U.S. Office of Personnel Management, Southeast Region, 75 Spring Street, S.W., Atlanta, Georgia, 30303.

GEORGIA

Examiner (State Supervisor), U.S. Office of Personnel Management, Southeast Region, 75 Spring Street, S.W., Atlanta, Georgia, 30303.

LOUISIANA

Examiner (State Supervisor), U.S. Office of Personnel Management, Southwest Region, 610 South Street, Room 804, New Orleans, Louisiana, 70130.

MISSISSIPPI

Examiner (State Supervisor), U.S. Office of Personnel Management, Southeast Region, 802 State Street, Room 403, Jackson, Mississippi, 39201. Address effective December 1, 1979: 75 Spring Street, S.W., Atlanta, Georgia, 30303.

SOUTH CAROLINA

Examiner (State Supervisor), U.S. Office of Personnel Management, Southeast Region, 75 Spring Street, S.W., Atlanta, Georgia, 30303.

TEXAS

Examiner (State Supervisor), U.S. Office of Personnel Management, Southwest Region, 1100 Commerce Street, Room 4C24, Dallas, Texas, 75242.

(Reorganization Plan No. 2 of 1978 (43 FR

36037))

NOTE: For FEDERAL REGISTER citations affecting this Appendix C, see the List of CFR Sections Affected in the Finding Aids section of this volume.

§ 801.207 Certification and publication of eligibility lists.

An examiner shall certify and transmit an eligibility list at least once a month to the office of the appropriate election official, with a copy to the At

torney General and the attorney general of the State. The list shall contain the name of each eligible voter listed since the last list was certified and transmitted. The list shall be made available for public inspection beginning on the last business day of the month and in any event not later than the 45th day before an election, during normal business hours, for one period of 10 consecutive days, at the place where the persons listed filed their applications as set out in Appendix A to this part, except that the list may be made available for public inspection in the same political subdivision at a place other than the place where the persons listed filed their applications when advance notice of this change is posted at the place where the persons listed filed their applications.

[30 FR 12392, Sept. 29, 1965]

Subpart C-Challenges to Listing on Eligibility List

§ 801.301 Scope.

This subpart prescribes the procedure that governs a challenge to a listing on an eligibility list under the Act. § 801.302 Basis of challenge.

A challenge to a listing on an eligibility list may be made only on the basis of fraud or that the challenged person does not have the prescribed qualifications.

§ 801.303 Time and place of challenge.

A challenge shall be filed within 10 days after the listing of the challenged person is made available for public inspection as provided in § 801.207 by delivering or mailing the challenge to the Examiner (State Supervisor), U.S. Office of Personnel Management, in the State involved at the address set out in Appendix C to this part.

§ 801.304 Form of challenge.

(a) A challenge shall be under oath and shall contain:

(1) The name and address of the OPM office to which it is submitted; (2) The date of submission;

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