Louisiana Administrative Code › Title 31 - ELECTIONS › Part II - Voter Registration › Chapter 4 - Voter Registration at Mandatory Voter Registration Agencies in the State that Provide Public Assistance or Provide State-funded Programs Primarily Engaged in Providing Services to Persons with Disabilities › Section II-407 - Declaration Form

Current through Register Vol. 50, No. 6, June 20, 2024
A. Each mandatory voter
				registration agency shall provide a declaration form with each voter
				registration application that is distributed with each application
				for service or assistance, and with each recertification, renewal, or
				change of address form relating to such service or
				assistance.
B. The
				declaration form shall include the following, in order:
1. the question:
"If you are not registered to vote where you live
				  now, would you like to apply to register to vote here today?";
2. boxes for the
				applicant to check to indicate whether the applicant would like to
				register to vote or declines to register to vote (failure to check
				either box being deemed to constitute a declination to register to
				vote for purposes of providing assistance in completion of the
				registration application form), together with the statement (in close
				proximity to the boxes and in prominent type):
"IF YOU DO NOT CHECK EITHER BOX, YOU WILL BE
				  CONSIDERED TO HAVE DECIDED NOT TO REGISTER TO VOTE AT THIS
				  TIME."
3. if the
				mandatory voter registration agency provides public assistance, the
				statement:
"Applying to register or declining to register to
				  vote will not affect the amount of assistance that you will be
				  provided by this agency."
4. the statement:
"If you would like help in filling out the voter
				  registration application form, we will help you. The decision whether
				  to seek or accept help is yours. You may fill out the application
				  form in private."
5. the statement:
"For assistance in completing the voter
				  registration application form outside our office, contact ___________
				  at ____________."
a. the
				first blank shall be filled in with the department's name and the
				second blank shall be filled in with the department's telephone
				number or other contact information;
6. the statement:
"If completed outside our office, this declaration
				  form and your completed voter registration application form (if you
				  filled one out) should be returned to __________ or
				  ____________."
a. the first
				blank shall be filled in with the department's local office physical
				location and the second blank shall be filled in with the
				department's mailing address used to accept applications for service
				or assistance, recertifications, renewals, and changes of address
				forms; and
7.
				the statement:
"If you believe that someone has interfered with
				  your right to register or to decline to register to vote, your right
				  to privacy in deciding whether to register or in applying to register
				  to vote, or your right to choose your own political party or other
				  political preference, you may file a complaint with the Louisiana
				  Secretary of State, Commissioner of Elections, P.O. Box 94125, Baton
				  Rouge, LA 70804-9125, Telephone (toll-free) 1-800-883-2805."