3rd Party Registration Drive Sworn Affidavit

To conclude this training, you must complete this Affidavit form.

 
This Affidavit form provides the legally required Sworn Affidavit attesting you will abide by all Virginia laws and rules regarding the registration of voters. Please be advised that criminal penalties may result from intentionally falsifying or misrepresenting material information on this form in violation of 24.2-1016.
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1. I am a staff member of a local voter registration office and am entering this information for an individual or group which completed the training in my office.
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2. Please enter the requestor's full name:
3. Please enter the number of voter registration applications you would like to order from the State Board of Elections (limit 200).
4. Please indicate if you are requesting these forms as an individual or on behalf of an organization(check as applicable).
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5. I will abide by all Virginia laws and rules regarding the registration of voters, including those stated below (please check each box below)
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6. If I am requesting these forms on behalf of an organization, I will use my best efforts to ensure that this organization will abide by all Virginia laws and rules regarding the registration of voters, which will include additional training and supervision of individuals working on behalf of my organization.
7. I have completed the training required annually available from the State Board of Elections either online or in-person or locally through the voter registration office;
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8. I understand that criminal penalties may result from noncompliance, intentionally falsifying or misrepresenting material information.
9. Please enter the following information:
10. Please complete the affirmation below:
I so swear or affirm.
I swear or affirm under penalty of perjury that all my statements and information I have provided in this form are true and correct.
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