“POLL WATCHER AUTHORIZATION FORM Representative of a Candidate I, ............................, state that I am a candidate for the office of ............................ in the ............................ election. I further state that I have designated ............................ as my authorized representative at the election at polling sites ............................ and absentee ballot processing sites ............................ in ............................ County, Arkansas, to observe and ascertain the identity of persons presenting themselves to vote in person or by absentee for the purpose of challenging any voter in accordance with Arkansas Code §§ 7-5-312, 7-5-416, and 7-5-417. I further state that I have designated and authorized my representative named above to be present at the ballot counting locations at ...............................................................

in ............................ County, Arkansas, for the purpose of witnessing the counting of ballots by election officials and determining whether ballots are fairly and accurately counted in accordance with Arkansas Code §§ 7-5-312, 7-5-316, 7-5-413, 7-5-416, 7-5-527, and 7-5-615

Representative of a Group I, ............................, state that I represent the ............................ group that is seeking passage/defeat (circle one) of the ballot measure entitled ............................ on the ballot in the ............................ election at polling sites ............................ and absentee ballot processing sites ............................ in ............................ County, Arkansas, to observe and ascertain the identity of persons presenting themselves to vote in person or by absentee for the purpose of challenging any voter in accordance with Arkansas Code §§ 7-5-312, 7-5-416, and 7-5-417

Representative of a Party I, ............................, state that I am the chair or secretary of the state/county (circle one) committee for the ...........................

party with candidates on the ballot in the ...........................

election. I further state that I have designated ............................ as an authorized party representative at the election at polling sites ............................ and absentee ballot processing sites ............................ in ................................................

County, Arkansas, to observe and ascertain the identity of persons presenting themselves to vote in person or by absentee for the purpose of challenging any voter in accordance with Arkansas Code §§ 7-5-312, 7-5-416, and 7-5-417. I further state that I have designated and authorized my representative named above to be present at the ballot counting locations at .........................................

in ............................ County, Arkansas, for the purpose of witnessing the counting of ballots by election officials and determining whether ballots are fairly and accurately counted in accordance with Arkansas Code §§ 7-5-312, 7-5-316, 7-5-413, 7-5-416, 7-5-527, and 7-5-615

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Signature of Candidate, Group Representative, or Chair/Secretary of the State/County Committee Acknowledged before me this .............. day of .............., 20.....

Notary Public: ...........................

My Commission Expires: .............

I do hereby state that I am familiar with the rights and responsibilities of a poll watcher as outlined on the back of the poll watcher authorization form and will in good faith comply with the provisions of same

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Signature of the Poll Watcher Acknowledged before me this .............. day of .............., 20.....

Notary Public: ...........................

My Commission Expires: .............

I do hereby acknowledge the filing of this poll watcher authorization form with the county clerk’s office

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Signature of County Clerk”