Affidavit of VBM Duplication Observer

VOTE-BY-MAIL Duplication Observer Affidavit

Sections 101.5614(4)(a) and (8), Florida Statute (2022)

Note: Upon request, a physically present candidate or their authorized designee, and one authorized representative of a political party and a political committee, respectively, may observe the duplication of vote-by-mail ballots after signing this affidavit and submitting it to the Office of the Supervisor of Elections for Broward County. All information on this form becomes a public record when submitted to the Supervisor’s Office.

I understand that Florida law permits only individuals who sign an affidavit to observe the duplication of vote-by-mail ballots.

Your Name

A candidate in the current elections;

Yes
No

An authorized representative designated by the following candidate:

Yes
No

An authorized representative designated by the following political party:

Yes
No

An authorized representative designated by the following political committee:

Yes
No

Under penalties of perjury, I declare that I have read the foregoing affidavit and that the facts stated in it are true.

I agree

E-Signature

Date:

Submit

Disclaimer

Understand that any person, who (1) willfully affirms falsely to any affirmation in connection with elections, (2)perpetrates any fraud in connection with any vote to be cast in any election, or (3) any person who releases any information about votes cast for or against any candidate or ballot measure or any results of any election before the closing of the polls in Broward County on election day, can be convicted of a felony of the third degree, fined up to $5,000, imprisoned for up to 5 years, and punished as otherwise provided by Sections77.082, 775.083, or 775.084, Florida Statutes.

By signing your name electronically on the last field in the form, you are agreeing that your electronic signature is the legal equivalent of your manual signature on this form

Contact Us

Hours of Operation
Monday - Friday
8:30 a.m. - 5:00 p.m.
(Excluding Holidays)

General Contact Information
Phone: 954-357-VOTE (8683)
Fax: 954-357-7070
elections@browardvotes.gov

Main Office
Broward County Governmental Center
115 S. Andrews Ave. Room #102
Fort Lauderdale, FL 33301

Voting Equipment Center
1501 NW 40th Avenue
Lauderhill, FL, 33313
(Entrance In the back of the Lauderhill Mall)