Office of the Wyoming Secretary of State
This form may be used when any person believes there has been or is about to be a violation of Title III of the Help
America Vote Act of 2002, P.L. 107-252. A letter in substantially the same form may be used so long as it is signed,
sworn, and notarized. Title III concerns voting system (machine) standards; provisional voting; voter registration, and the
registration list requirements.
If this form indicates other possible violations, the Complaint may be referred to other
authorities. A person with a complaint may also speak or write directly to local election officials.
This form must be filed within thirty (30) calendar days of the date of the alleged
violation, and it must be sent to the Wyoming Secretary of State, Elections Division, State
Capitol Building, 200 West 24
Street, Cheyenne, Wyoming 82002-0020. For prompt
resolution, it is helpful to have all pertinent information be provided as requested below. If space
is inadequate, please attach additional pages.
Printed name of person making complaint _____________________________________
Telephone number(s) ___________________ E-mail address ______________________
State the facts of the alleged violation including date, time, place, and relevant actions of
In which category do you think the complaint belongs?
Voting machine standards.
Voter registration, registration by mail, and identification required.
Voter information requirements.
Computerized voter registration list standards.
State the requirement that you believe has been violated or which is about to be violated,
and, if you know, identify the section, subsection, and paragraph of the law stating the
This form is available in alternate formats from the Secretary of State upon request.