Montana Secretary Of State Corey Stapleton
Electronic Ballot Request System For Voters With Disabilities

Note to Voter: You must read and accept all statements below before continuing.

I, the undersigned, hereby swear/affirm that I understand and agree with each statement below.

1.

I am qualified to vote an electronic ballot under Montana law because I am a person with a temporary or permanent physical impairment such as impaired vision, impaired hearing or impaired mobility pursuant to 13-3-202 MCA;


2.

I am registered to vote in Montana (or am entitled to vote in this election because of special provisions) and have met the 30 day residency requirement;


3.

I have not submitted another ballot for this election and I understand that attempting to vote more than once is a violation of Montana election laws;


4.

I understand that failure to complete the required information in this site will invalidate my ballot;


5.

I understand that by choosing to vote an electronic ballot, my submitted ballot will be transcribed by no less than 3 election officials;


6.

I am a citizen of the United States;


7.

I am at least 18 years of age on or before the next election;


8.

I am a Montana resident for at least 30 days before the next election.

I have read and agree with each statement above.