Alabama Voter Complaint (Page 2 of 2) in pdf

___________________________________________________________________________________________________________

Person(s) or entity against whom Complaint is Alleged

Name(s)_________________________________________________________________ Entity (if any)______________________

Location of Violation__________________________________________________________________________________________

City ____________________________________________________________________ County ___________________________

I would like the Secretary of State to conduct a hearing on this matter.

Yes

I have attached additional documents or sheets to this complaint form.

Yes

Sworn Statement of the Voter Making Complaint

State of Alabama _______________________________________________________________________________________County

I swear/affirm under oath that all statements made in this complaint are accurate, true, and correct.

________________________________________________________________________

Signature of voter

________________________________________________________________________

Printed Name of Voter

________________________________________________________________________

Signature of Notary Public

________________________________________________________________________

Notary’s Commission Expires

Accommodations and Mailing

Any person with a disability may request accommodation in order to participate in the administrative complaint process. Requests for

accommodation should be made at the time of filing the complaint. Requests for participants other than the person making the com-

plaint should be made ten working days before the accommodation is needed. Requests should be made to the Legal Division of the

Secretary of State’s Office, (334) 242-3942 or 1-800-274-VOTE. Accessible parking and entryways to the Alabama State Capitol are

located near the Union Street entrance.

Please mail your completed form and attachments, if any to:

Office of the Secretary of State, 600 Dexter Avenue, Room S-105

Post Office Box 5616, Montgomery, Alabama, 36103, 334-242-3942

Alabama Voter Complaint Page 2