3 GCA § 10110: Voter’s Affidavit on Envelope.

On the reverse side of the envelope prescribed in § 10109 shall be printed a blank form of an affidavit in substantially the following form:

“AFFIDAVIT

District or Municipality

of___________________________, Guam

I, __________________________, do solemnly swear

that the

(Print or type full name) following matters

relating to my qualifications for registration and voting are

true:

Place of Residence: ___________________ (municipality,

municipal, division or district), Guam.

Date of Birth: __________________________

(Month/Day/Year)

Place of Birth: __________________________

Method of which United States citizenship was attained:

Qualified voter: __________ (yes or no)

That I am not confined to a mental institution or

judicially declared incompetent; that I am not serving a

criminal sentence; that I am not voting in any other U.S.

jurisdiction; that I am in the business/work of

_____________________; and that I shall be absent from

the polls on the day of election on account of

______________.

________________________

Signature

Subscribed and sworn to before me this ____ day of

______, 20___, and I hereby certify that the affiant

exhibited the enclosed ballot to me unmarked; that the

affiant then in my presence and of no other person, and in

such manner that I could not see his vote, mark such ballot

and enclosed and sealed same in this envelope; and that the

affiant was not solicited or advised by me for or against any

candidate or measure.

_________________________

Print or type full name

_________________________

Signature

_________________________

Title or Rank”