Fill - Free fillable All voters in line at 7 pm are (Tom Green County) PDF form

All voters in line at 7 pm are allowed to vote before closing polls.

To CLOSE polls, there are many things to do = gathering in signs, etc. from outside an on the

door, paperwork, and returning supplies to the election office.

Before shutting down Verity equipment and the Kiosks, the judge will need to verify Ballot

count on the Controller and get counts from the Kiosks by checking counts/logs and verifying

provisional count. These figures are needed to balance the paperwork.

Instructions are included in the supplies that include a step-by-step checklist for closing the

equipment.

When closing the Kiosks, the tablet must be the first thing that is powered off. Everything is

repacked in the Kiosk case. The units will be sealed and the seal numbers recorded on the

paperwork. Be sure to retrieve the data gizzard, turn it off, and put it in the Kiosk delivery bag

with the kiosks. The battery backup unit should be powered down and returned to the delivery

tub.

When powering off the voting equipment, the power must be turned off to the individual

units, the tablets docked and locked, and the case closed and locked. Seals will be placed on

the outside of all the units and these numbers are recorded on the paperwork. Disconnect the

power cords and daisy chains from the voting equipment and place them in the Verity delivery

bag. Remove the voting units from the stands, fold the stands and pack them in the booth

bags.

Everything that will be left in the poll will be put together for pickup. Paperwork will be

completed.

Two people, usually the judge and alternate judge, will return the following

to the election office: Controller, Yellow Judge’s bag,

Provisional Ballot Box, Ballot box #3 and the Kiosks (with

data gizzard).

FAILURE TO RETURN THE REQUIRED ITEMS TO THE ELECTION OFFICE

ON ELECTION NIGHT WILL REQUIRE A RETURN TRIP TO THE POLL TO

RETREIVE THE ITEM.

Poll

Location:

Vel

Contact Person:

I

DELIVERY

~OG

PAGE

Deliverto:

Angelo Bible

Contact #:

Equipment:

SeriallD

#

Seal

#

Factory

Seal"

Technician

Seal # Returned

Delivery:

Date

&

Time

or

Name

ACCESS

TOUCH

A1801967112

Departure

Time:

AM

PM

ACCESS

TOUCH

A1801967812

Arrival Time:

AM

PM

Completion Time:

AM

PM

TOUCH

T1901972501

Received by:

TOUCH

T1901973701

Name:

TOUCH

T1901980501

Name:

TOUCH

T1901983901

Pickup:

TOUCH

T1901984201

Departure

Time:

AM

PM

TOUCH

T1901991201

Arrival Time:

AM

PM

TOUCH

T1901995201

Completion Time:

AM

PM

TOUCH

T1901998101

Picked Up

By:

TOUCH T1901970801

Name:

Supplies:

How

Delivery Bag:

Vinyl Envelope

many

Tech

Green

Seal

Green Paper Seal #:

I,

the

Precinct Judge for the

Booth Stands

Election, do hereby certify

that

the

seal number(S)

Verity Bag

listed above are a true and correct list

of

the

seals

Kiosk

Bag

Judge's Green Seal

Red

Paper

Seal

#

used

on

Election Day.

Trifold

(5)

Delivery Tub

Record

all

red

return

seals

for

all

equipment.

Orange Cone(s)

RETURN

Red

Seal

Boxed

supplies

are

placed

back

in

delivery

bag,

and

Judge's Signature

supplies

to

be

picked

up

by

election

staff

are

placed

Table(s)

together

with

equipment.

Signs

Return

this

form

on

clipboard

to

the

Judge's

Bag.

Alternate Judge's Signature

US

Flag/PVC Pipe

PRIMARY

ELECTION

03/03/2020

Yellow

Banner/Poles

Tech Green: Remvoed when delivered

at

poll,

VC

Yellow and Pink (leave on clipboard): Return in Yellow Judges bag

at

end

of

ED.

Seal numbers will be listed

in these spaces. If a seal

was broken after the

equipment was

programmed a new seal

number is recorded in

"Seal # Technician." Verify

the seal numbers before

breaking them.

Record the

seal numbers

placed on the

units. Make

sure the

correct

number is on

the right unit.

Also verify that

the unit is

closed

properly and

locked.

SPECIAL

ELECTION

Electionm Date 11/05/2019

You

will need to use this/orm at the poll to verify the seriall.D. and seal numbers included

on

this/arm.

Vote

Center:

# 1

ANGELO

BIBLE

Controller 1 Serial #:

C1801770908

vOrlve

#

Receive

Seal

#:

Controller 2 Serial #:

vOrive

#

Receive

Seal

#:

I-----....,f------l

Check-In Kiosk

Unit

II:

1

Receive Seal II:

r-------+-----~

Forms Kiosk

Unit

#:

21

Receive

Seal

II:

______

L-

____

~

Judge's Signature

Judge's Phone II

Judges:

Please

be

sure

to check that Ballot

Box

#3 and Provisional Ballot

Box

were delivered

to

poll

and

verify

Seals

and

Locks.

Ballot Box #3: Delivered Not Sealed. Return with lock which is

In

the

box.

lock

It:

VC

1

Red

Wire Seal 8

Green

Wire stat

Door

Seal It: •

Provisional Ballot Box:

Judge must return and record items listed below:

Controiler 1 Serial #:

C1801770908

vOrlve

#

Return Seal II:

Controller 2 Serial II:

vOrive

#

Return

Seal

#:

Check-In Kiosk Unit II: 1

Return Seal

II:

Forms Kiosk Unit II:

21 Return

Seal

II:

Return

Seal

II:

Rflurn

Lock:

Ballot Box

113:

lotk

II:

VC

1

Red

WIre Setllt:

Red

WIre

Slot

Door

Seal

~

Provisional Ballot Box:

Power Cords:

0

Yes

0

No

Judge's (Yellow) Bag:

DYes

o No

Facility Keys Returned:

0

Yes

0

No

WiFI Returned:

DYes

o No

•

.sweat/affirm

that

the

above..aisted

serial/seal

numbers

match

the

serial/seal

numbers

belng

returned

to

the

E1ectlon

Office.

If

not,

I

have

provided

an

explanation

below,

Explanation:

______________________

...-

_________

_

Judge's

SIgnature

Printed

noml!'

J,

the

undersigned

outhorind

elm

oj

the

centrol

counting

starfan_

do

hereby

acltnowledQe

receipt

o}

~

above-listed ir.ms for

VC

1,

The

items

were

deilwIred

by

(please

print}:

__________

and

__________

, two outhorized

electIon

t1/!1ce"

oj

rhot

precinct

and

the seal numbel'$

match

at

tIu!

tlmf!

of

deltllftry,

Signature

~

Centl'(li

Counting

Arrival Time

Departure Time

NOTE:

Contact information

for

Election

Office:

659-6541 or

Vena:

234-7466

Tech

Yellow:

Removed

at

Dock

pickup,

VC

Yellow

and

Pink

(Leave

on

clipboard):

Return

in

Judge's

(yellow)

bag

at

end

of

ED,

Seal numbers will be

listed in these spaces.

If a seal was broken

after the equipment

was programmed a

new seal number is

recorded in "Seal #

Technician." Verify the

seal numbers before

breaking them.

Seal numbers will

be listed in these

spaces. If a seal

was broken after the

equipment was

programmed a new

seal number is

recorded in "Seal #

Technician." Verify

the seal numbers

before breaking

them.

Record the seal

numbers placed

on the units.

Make sure the

correct number

is on the right

unit. Also verify

that the unit is

closed properly

and locked.

Record the seal

numbers

placed on the

units. Make

sure the correct

number is on

the right unit.

Also verify that

the unit is

closed properly

and locked.

Needs to be completed

Completed by election office

Examples of seals

Red seals are not broken and should be reported if a

one is found broken.

Green seals should be broken for use during the day.

PROVISIONAL

BALLOTS

Vole Center

loca

t

io

n

Authorit v conducting election

Da

le of Election Type

of

Election

BALLOT

AND SEAL

CERTIFICATE

We, the

undersigned

election officials,

do

hereby

certify

that

all voted ballots

were placed in the

transfer

case

or

cases to be

transferred

to

the

central

counting

station.

The

number

of

ballots placed in the

carrying

case

or

cases

was

__

_

The

Serial

number

of

the seal

that

was

used to seal

the

transfer

case

or

cases was

Witness my

Hand

this

___

day

of

_______

, 20

__

Signnturc

of

Pre

s

iding

Judge

Poll

Walcher

(if

ally)

Sign:lturc

or

Election

Clerk

Poll

Watcher

(if

any)

Complete

form even

if

f>r

.,\'

i,

i

onal

bo\ i,

cmp

l)'

~en

l

R

'

~

""III ht' \

cr

i

(iC'

tl

,~

hc

n

boU'\

fth'

rt'

t

ll

f

n~

·d

10

('i.'Iur

al ( ·O

Ulll

ju g

SI

.. tloll.

Place Kreen c

op

y inside Provisional Ballot Box,

yellow

co

py

leave inji.J!der

and

return

/old

er in yellow bag,

and

pla

ce

th

e

Pink

co

py

in Pink envelope

This form must be completed unless you do not have any provisional ballots. Be sure to

complete all the empty spaces.

'

1'111

o~

CDunI)'

Admlfl1prW\.lun

t.'nmperulillun

FornI

"Mlrm"C4

b)

,

rk

St.

'I;~~f}

of

Sailhi'

JIoII}

7.

2008

H~f

lorl'l Gft't'n C'0ti1

1l}'

A«mrnllnl!!

Pl.Jrp(lliC

~

OnlYI

STATEMENT

OF

COMPENSA

nON

and

OATHS

Name

of

Election Official

(Please Print Legibly)

Co

mplele Address

(j

, dude

CilY

Zi

o)

So

cia

l Security Number

-

Ho

me

Phone

(

)

Ce

ll

Phone (

)

email:

,

P

os

ition \Vorked'

Signature

r sl

ate

that the above

is

n true ond correct

statement

of

the name, a

ddr

ess and hours served

of

the a

bove

lI

umcd elect ion oflicial conducting

the

above

rl(u

ncd election

Hnd

of

th

e other

expe

nses incurred in th is election.

Presiding

Head Clerk/.Judge

Leave

pages in folder

".

swear

(or

affirm)

that'

will not in any

manner

request

or

seck to

persuade

or

induce

any

voter

to vote

for

or

against

any

candidate

or

measure

to be voted on,

and

that

1 will faithfnlly pe

rform

my

du~

'

as

an

officer of

tbe

election

and

guard

the

purity

of

the

election. I

swear

(or

affirm)

thnt

1 will

not

suggest, by

word,

sign

or

gesture,

how

the

voter

should vote; I will confine

my

assistance to

answering

the

voter's questions, to

stating

the

proposition

s

on

the

ballot,

and

to

naming

candidates

and,

if

listed,

their

political parties,

and

I will

prepare

the

voter's

ballot as

the

voter

directs,

and

I

am

not the

voter's

employer,

an agent

of

the

voter's

employer,

or

an

officer

or

agellt

of

a

labor

union to

which

the

voter

belongs."

Pel.

No

Authori

ty

Cu

ndu

ctlng

[f

tX

li

OIl

Date

T

ype

of

Electi

on

Hours

Worked

Poll

T

Ol

al

Rale

Payro

ll

,,,

,

...

I

-;;;;~I

from To

Hours x o

fP,

Am

o

unt

h

!oC

tl

nl)J

Worker

Please check in and

out when a lunch

is

tak

en

. See

example

~l

not

sure

/rOU'I

O record.

To

be

co

mpl

el

ed

by

Tube

f.:O

lJ1pl

e

led

hy

El

ect

rite

Judge

>

ion Offi

ce>

D('livcry Fee

Training

Total

This form must be completed in its entirity. Record time in 15 minute

increments and show am and pm on the time. If lunch is taken, log out

and in. We cannot complete payroll if there is no social security, no

complete address and/or signatures. The Pct. No. is the where the work

is performed (vote center in most cases), the Autority conducting election

and type of election may be found in the purpole information folder.

AW1·l6

Pr

rw

d

fl

y

~

e

t

iifY

Qf

!l

toit

.

~ctlol'r

nOll,

lexas f lection

Co

de:

1

<),11.<

Ty

pe

or

Ehxtion

EV

Blilnch/Vote

Cente

r

Dat

e

01

Ek!

ttion

A

uth

o

rity

C

ancuct

i

nr:

El

e-ct

\on

List

of

Provisional Voters

To

be

Completed

by

the

Election Judge

,

To

be

Completed by the Ballot

Board

Judge

Name

of

Provisional Voter

Ac

ce

pted for Counting

Re

ject

ed

for Coun

ti

ng

1

2

3

4

5

6

7

8

9

10

II

12

13

14

15

16

17

18

19

20

21

22

23

24

25

Number

of

PrOVIsIonal Ballots

In

Ballot

80)(

las

shown

on

Irst)

I certi

fy

that

the

numbers represented above are

true

and correct

as

evidenced

by

my

signature.

Signature of I>'ec

inct

Presiding Judge:

Signa

ture

of

Cus

tod

ia

n receiving baJiots

Ir

om

PreSiding Judge:

'Si8na~1Jreo

f

Voter Registrar: _ _

___

_

___

_

____

_

___

_ _ _ _ _ _ _

___

_____

_

SEPARA TE FORM: Place green copy in Provsionol Bol/ot

Box

,

yellow

copy in

ye

llow

bog,

and

pink

copy in

pink

en

ve

lo

pe

This form is completed with the names of all provisional

voters. A form will have to be completed at central

count if it is not done in the poll. Be sure to separate

according to the instructions at the bottom of the form.

Must be completed. The information

needed may be found in the purple

information folder.

Complete

,\

W7-1

I'

rt

~~

n

h('d

h\

S

Cl"

rclarv

of

Sla

ll:

S

..

'

C'lIom;

(lI.

C)

!'

and (vi

(U4

"

T

cxu

~

Ekct

lon

Codt

\)

' I

~

Vote Cen

te

r · Pet No,

(N/ill! D('

Pr

im

AUthority Conduc

ti

ng Election

(Aul

or

idwJ A

dnlln

J

JI'l

mil

lJ la V ecci6n)

Dille

or

E

Il'e

lion

(I'ec/'o de

k:J"'

~

ll

l/I

)

Type

of

EJectiun

(1'1

110

d

t!

Elecc

ldl1

)

OATHS

(JURA ,

HENTOS)

ASSISTANCE

(ArUDA)

(Sec 64.034)

OATI-I

OF

PE

RSON

AS

SISTING VOTE

R:

I swear (or affirm) that I will not suggest

by

word, sign, or

ge

sture how

the

vo

ter

s

hall

vote; I will confine

my

assistance to answering

Lhe

voter's questions,

to

stating propositions on

the

ballot.

and

to naming candidates and, if

li

st

ed, their political partic

s;

I will prepare the ,'oter's ballot

as

th

e

voLer

directs; and I

am

not

the

voter's cmployer,

an

agent

of

the voter's employer, or

an

officer or agent o

fa

labor union to which

the

voter

bd

o

ngs

, (JU

RA

MEN

TO

DE I,A PERSONA Q U I:: A )

'U

DA:1L V

OTANTf:

}'"

(Jjuro (0

(~fiJ'm

oj

(/IU

~

no

slI

ge

l'if

e

pO

I"

palabra, sena 0

acc

i

rin

(:

ci

mo dl!

her

ll votar

t:I

vOIunle:

!ifni/an

}

mi

£lyu

da

a cOl1lesfar las I)I'

CK

IIII/(JS

del

vula

nl

e,

(f

de

claro/' las

pr

oposi

ci

a

lJes

en

I"

bu/e

fa, Y

()

I/

omb

ra

r los c

andida/

Os

y, si Iist

ad

o:>.

,

1m

'

portid

os

p u

lili

cos a 1/11i: p

erl

enecc

JI

;

yo

prepul"arrJ

la bo/cia " I

JII

l{) rlirUa el volant

e.

l '

no

SO )' el

e/llplcador (

kl

Volante, agenti! del emp

/4.!

lI£

lor,

()

lfIl

(!/icia/ 0 agc

l1le

de

1111

,

rincli

c

fflo

d017d

e e/1'ofaJ1le p erlt!n

ef-

"

e,

INn

:HPRETEH (fNTE111'IIETE)

(Sec 61035)

INT

ERPRETER'S OATIl: Jswear (or affirm) that, to

th

e

be

st al'my ability, I will correctly interpret and translate each

question, answer, or statement addressed either

to

the voter

by

an election officer or to an election onlcer

by

the

vo

ter.

(JU

R/IMI

:.

",/I

,./T()

DEL

IlVTERP/?£T£: Y

u/

ur

o (u

({/irm

o)

qu

e, a

1111

Ifl(;j

or

po(('nc:ia, inlerprel

(J

l"ey Iradlll:ird de una

mun

erO carrec/o cada

pl'

tg

Ul1lu

respllt!.\"I

u 0 declal'aciun

qu

e eua/qllier

(~/

i

cial

elc.:t.:/oral

dit/ja

al

VOlanl

f! 0 que' e

ll

'o/anfe dirUa a clIal'luier q/i

cial

elect

ora

l.)

The above oaths were sworn and subscribed to before me

thi

s _

__

day 01'

-:

,-,_

,-,

_.,.-

_-,-

, 20

__

_

U os juramel1los

,\'

ei

111/(ld

o.\'

(ll'fi

b

ajll

eron dec/uf

ado

.\'

b'

~

ioj

llrameflf

t)

y ,w

sc

nf

ru

unl

e (I'll e

nla}

'

el

l((

ind/cada

w -rihu.)

ELECTION

OF

FIC

ER

lon

elAL £L

EC

TO

R

AI

.!

Be

sure

to

write

the

name

of

the

assistant on the check-in combo form.

Return

in

white

bag.

This form will be available

at the forms table but the

assistant is now signing on

the Kiosk tablet. This form

may be required for

curbside voter assistants.

AWS-17

Prescribed by Secretary

of

State

Section 84.032,84.038,86.0015 Texas Election Code

REV

1012018

REQUEST

TO

CANCEL APPLICATION

FOR

BALLOT BY MAIL

To

be

completed by all voters intending to cancel

their

Application

for

Ballot

by

Mail:

I,

---------:-::--c-::--------~'

a qualified voter for the

____________

_

(Print

Name)

Election to be held

on

1

__

1,

___

request that my Application for Ballot by Mail be cancelled.

(Month)

(Day)

(Year)

f~~T"""""'-~'I''"'~''-~''>tM~~'4W''''''''''''''''-~~-''''"",",,''''------''''''''''?'''-:>II'

1_~""

__

-

__

~

____

~::='':ZZl'_-''--'-;_"'''''''

w

!

Vl

b i STATEMEJliT

j

<C

.....

! I am returning

my

mail ballot/presenting a Notice

of

Improper Delivery (circle one) to the early voting

I

~ ~

I clerk/deputy early voting clerk/presiding election judge (circle

the

appropriate

officer) and canceling my

I

j:!:!

.....

I ballot by maiL

0<1:1 X

>~

Signature

of

Voter

l l

if~-

qjl*""""'!;~""',,,,,,j!;N

%H_";->"'1t[.¥-~,_-"t-:.:.,.,,,.jo<*,,,,'W'?_,,

""--~",",,,,:,,,>~>W'-.&.~~,~,,,,,*-=,,,,,,t~;.$;""'F-:_~_'r,",,-=---"'

__

~

___

..:ww..$

__

~.'1:'1'~,

i !

AFFlDA

VIT

A

1

~

Affidavits A

and

B

are

only executed in person

at

the early voting clerk's office. These Affidavits Ilrt only used when the

i voter

is

canceling hislher applicatiou with the

EV

e1erk after the close

of

early voting

by

personal appearance

or

on

Election

,

~

Day,

I

c I,

------::c-:-.:-:----:---:---~'

do hereby affirm that I have not received my mail ballot

at

the

! (Print

Name)

I

i

!

time

of

making

my

request to cancel

my

Application for Ballot by

~_ai_L

______________

_

.1

,

f

.....

OR

Signature

of

Voter

<I:

2:

;

AFFIDAVIT

B

!

w

I I,

_____

-:-::-:_-::--:

_____

' do

hereby

affirm that I

have

not requested a mail

ballot

::>

!

i

<,(

i (Print

Name)

b

J:

i

X-------·------------------

lOR

z

Signature

of

Voter

\I)

!

I

w

AFFIDAVITC

o

Affidavit C

is

only executed in person

at

the

early voting

tJerk's

office.

It

must be executed before

the

<:artier envelope

Is

C

delivered to the early voting ballot board.

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LU

,

t

I hereby

request

that

my

mail

ballot

be

canceled.

I,

__

-::::-:---:,.,-_,--

__

affmn that I did not

b

1

(Print Name)

::>

I

!

mark

my

ballot

that was sent to

me

by

maiL

X------------------------

I

Signature

of

Voter

t

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,

This

section to

be

completed by

early

voting

derk,

deputy early voting clerk,

or

election judge.

VUID

____

_

Name

of

Voter

Voter's Precinct Number

____

_

(Print Name)

Sworn to and subscribed before me, this

___

day

of

__

~

..

~_

..

________

~

____

,20

__

~~-

(Month) (Year)

x

__

~----~~~~

__

~-~

Signature

of

Officer Administering Oath

Denied

____

Reasoo

____

.

______________

Date

--1--1--

]

This must be completed by any voter that votes in your poll regardless

of whether they turn in a ballot or are voted provisionally. Place

completed form in the envelope. If the voter surrendered their ballot you

will put it in the envelope as well.

/1

'

,1/1

.8

P1fl;tc,,/

'

o.d

by

Secretary

c.f

Slare

Se

:::

nan

ft

1.0070

Tex

as

So.:

:;.el

ary

01

S

lil

l

!'

3107

Election: Constitutional

Date:

1110312015

Vote Center:

Notice of Total Number of Voters Who Have Voted

(Aviso del Numero

de

Volanles Que Han Volado)

Number of Voters

(Numero de Votantes)

9:30 AM

11:30 AM

1:30 PM

3:30 PM

5:30 PM

Signature

of

Presiding Judge

(Firma del Juez Presidenle)

NOTE TO PRESIDING JUDGE:

The total number

of

voters as shown on the poll list shall be posted at the times

listed. The notice shall remain posted until the polls close .

Return this form

in

White Bag to the general custodian of the

election records.

NOTA AL JUEZ PRESIDENTE:

Ef

nlimero

de

votantes

estab/ecido

en /a lista de

votantes

se

mostrara

a

las

horas

seflaladas arriba. EI

aviso

quedara

puesto

hasta

que

cierren

los

s;t;os

de votac;on.

Devuelva esta

forma

en /a

bo/sa

amarilla (el

sobre

nlimero

2) a la

persona

a

cargo

de

los

archivos

e/ectora/es.

This form is completed through the day

and must be returned to the office at the

end of voting.

EV BranchlVote

Center

#:

__

_ _

Date:

All Poll

Workers:

You

must

read, sign and date

that

you have read the Tom Green

County Computer Security Policy

on the

left:

of

this signature

form. By

signing

you are affirming

you

will comply with this

policy.

Date Name SiQnature

,

Leave this signed form

in

this folder.

Poll workers MUST read the computer policy and

sign that they have done so.

Cancelled Check In Voter List

VOTE CENTER LOCATION ____________________

ELECTION: ___________________________

DATE: _________________

CERT # LAST NAME FIRST NAME

REASON FOR CANCELLATION

[Place label in

sleeve or if label is adhered to combo sheet, with a red pen write "cancelled" across label]

Judge's Signature

Write "Cancelled" on the 3 VoteSafe labels in red and initial. If not taped to forms, insert them all in the un-used labels sleeve . Once the vo

ter has been Cancelled their screen will

look like an original voter check in screen.

Cancelled check in voters are not counted in totals.

RETURN THIS FORM WITH YELLOW CHECK - IN SIGNATURE FORMS

USED OR NOT

(

Party

Affiliation

Change

requested

changed

to

...

~----------~------~~~----~

Name

IAddress

Republican

I

Democrat

Republican

j

Democrat

comment

1-----------11-----------;

--------...1.---

..

---'

Sleeve:

Beginning

of

Day Access Code

Report

Election Day

Elec

ti

on:

Vote Center:

Date of Election :

Aut

hor

ity Conducting Election.

Beginning

of

Day Public

Count

from

Judge's

Booth

Controller

(.TBC)

1

Beginning

of

Day

Public

Count

from

Judge's

Booth

Controller

(JBC) 2

From

Judges

Booth

Controller

(JBC)

Access

Code

Report

__

Check

to

indicate

JBC

tapes

have been

placed

in sleeve.

Signature

of

Judge

Leave

sleeve

in

folder,

return

entire

folder

in

YELLOW

BAG

Sleeve:

Beginning

of

Day Access Code

Report

Election Day

Elec

ti

on: Vote Cen

te

r:

Date of El

ec

lion:

Authority Conducting

El

ection:

Beginning

of

Day

Public

Count

from

Judge's

Booth

Controller

(JBC) 1

Beginning

of

Day

Public

Count

from

Judge's

Booth

Controller

(JBC) 2

From

Judges

Booth

Controller

(JBC)

Access

Code

Report

_ _

Check

to

indicate

JBC

tapes

have been

placed

in

sleeve.

Signature

of

Judge

Leave

sleeve

in

folder,

return

entire

folder

in

YELLOW

BAG

Complete any blank line

and place tapes in this

sleeve.

Reconciliation Form

Line #1 Count the number of “signature” labels you have in the check-in combo notebook.

Line #2 This total is found on the Kiosk counts/logs.

Line #3 This total is found on the Kiosk counts/logs, provisional tab.

Line#4 This count is voters that were processed If the Kiosk was not working and you had to

handwrite labels or you have limited voters in early voting.

Line #5 Add the totals from line 2 and 3 and 4 and put that total here. (This line should equal line

1)

If you have any cancelled voter check-ins, record them below line 5 total. (Voter check-

ins will be cancelled if the voter left the poll without voting, if the wrong voter was

checked in, or in the primary, if the voter changed their party choice while at check-in. It

is not necessary to cancel the check-in and check a voter in again if they change their party

choice once they are at the ballot station. If they are at the voting booth and change their

party choice, there is a form called “Party Affiliation Change” that this information is

recorded on.

Line #6 Look at the Ballot Count on the controller and record that here.

An access code report should be printed and the following will come from that tape:

Line #7 From the tape, record the number of codes issued.

Line #8 From the tape, record the number of codes voted.

Line #9 From the tape, record the number of codes open.

Line #10 From the tape, record the number of codes in progress.

Line #11 From the tape, record the number of codes expired.

Line #12 From the tape, record the number of codes deactivated.

Line #13 Record spoiled ballots that were spoiled because the voter did not cast the ballot.

Line #14 Record spoiled ballots that were spoiled because the voter requested a change.

( a change can be 1) the voter decided they want to return to vote later and the voter

Check-in should be cancelled also, 2) the voter decided they wanted to vote a different

party than they originally indicated and this change is noted on the “Party Affiliation

Change” form.

Line #15 Record any emergency ballots that were prepared and used.

Line #16 Add lines 8 and 13 and 15 and record that number here. (The total should equal line #5).

Record any provisional ballots that were placed in the provisional ballot box. (Provisional

votes are not included in the totals on the access code report but show at the bottom of

the tally tape.

Obtain the signatures at the bottom of the page and separate according to the instructions.

Election Day Reconciliation Form

Laptop Balancing

This information is based on information from all Kiosks (WVK) and combination forms.

1

How many signatures do you have on all Combination Forms?

(Count signatures from all combination forms, including provisional, limited, and handwritten labels); will

not include cancelled check-in labels

2

How many voters are shown checked in on the WVK Count Log?

(All WVK's (Confirm there are no mistaken cancellations of voter check-ins.)

3

What is the total Count shown on the WVK(s) Provisional tab in the Counts/Logs? (All

laptops)

4

Do you have any voters that you were unable to check in on the WVK? If yes, how many?

5

What is the total of lines 2+3+4?

Line 5 should equal Line 1

For record, how many cancelled voter check-ins did you have?

(Complete the "Cancelled Voter Check-in Form?")

Voting Equipment Balancing

This information is based on the voting equipment.

6

What is the ballot count on the Controller?

(Look at the BALLOT COUNT on all CONTROLLERS)

How many emergency ballots are in the Provisional Ballot box?

After Access Code Summary Report is printed:

7

Total Codes Issued?

8

Cast?

9

Open? (should be 0)

10

In Progress? (should be 0)

11

Expired?

12

Deactivated?

Spoiled? (Complete 13 and/or 14)

13

(Spoiled because the voter did not cast the ballot)

14

(Spoiled at voter request (return later)

15

Emergency ballots

16

What is the total of line 8, 13 & 15?

(Should equal line 5)

How many Provisional Ballots did you place in Provisional Ballot Box?

(Should match the number of Provisional listed at the bottom of the tape)

Spoiled for record only - cancelled at voter's request (return later?) _____

Head Clerk Signature

Alternate Head Clerk or Clerk's Signature

For #1, count the labels generated when the voter signed on the tablet.

#2 comes from VoteSafe on the Kiosk.

#3 comes from VoteSafe on the Kiosk.

#4 will equal anyone that was processed but the check-in was not completed, the Kiosk was not working, and

in early voting, was voted Limited.

Only use the line numbers

mentioned

Record any voters that you cancelled the check-in on the

Kiosk.

#6 - look at the ballot count on the controller.

If the controller was not working and voters voted with a sample ballot, etc. record the total in line 15.

You will print an access code report.

#7, 8, 9, 10, 11, and 12 will come from

this tape.

#13 equals ballots that the voter left open on

the touch/access and the ballot was cancelled.

#14 will normally be 0. If a voter requests that a ballot be cancelled, you

will record that here.

#15 - Record any ballots that were not cast on the touch/access units.

Only use the line numbers

mentioned

Record how many provisional ballots are in the ballot

box.

# 5 should = #1

# 16 should = # 1

Examples of labels taped down in check-in notebook.

Examples of labels taped down at the Forms Table.

These must be counted with the labels from the Check-in

Table. Watch for Cancelled written on labels because

these are not included in the count for the signature labels.

Also, a separate green provisional sheet is provided in case

the poll wants to place them on a separate sheet. The

provisional labels are counted for line 1.

Randomly

sign and date

sheets.

Examples of labels taped at

the Ballot Station.

These labels are in the Red Reconciliation Folder. Complete from the bottom

right-hand corner if used. This will count as a "signature label" when counting

labels for line 1 of the reconciliation form.

Cancelled Booth Log

.

Election: ________________ Polling Place: ______________ Date of Election:___________ Authority Conducting Election: _____________

Directions for Cancelled Booths: If you must cancel a booth use this log to record the date and time cancelled,

who cancelled the booth, and the reason it was cancelled. Expired codes are placed in separate sleeve.

[Thrown Out = Voter did not cast ballot] [Spoiled = voter chose wrong language or we gave them wrong ballot style]

Date

Time

Cancelled by

Voter didn’t cast

ballot (√)

Thrown Out

Voter chose wrong

language(√) Spoiled

Voter given wrong

ballot style (√)

Spoiled

Other

If USED, place in FORMS SIGNATURE ROSTER ENVELOPE. If NOT USED, leave form in Ballot Station Binder.

This form is used to record spoiled

ballots due to voter not casting the

ballot. It can be used to double check

the thrown out totals on the

reconciliation form.

AW7-5 3/07

Election: ___________________

Prescribed by Secretary of State

Date: _____________________

Section 64.007, Texas Election Code

VC#: ___________________

Tom Green County, Texas

DATE

NUMBER ON BALLOT

(Número Sobre la Boleta)

precinct

TO WHOM GIVEN

(Persona Que la Recibió)

Given under my hand, this ________ day of _________________, 20 ____

(Ejecutrado bajo mi firma, este dia ______ de _________________, 20 ____.)

Presiding Judge of Election

(Juez Presidente de la Elección)

(SI USO EL SOBRE, DEVUELVALO EN LA BOLSA DE JUEZ (AMARILLA). SI NO FUE USADO, DEJE EL SOBRE CON LAS BOLETAS QUE NO

FUERON USADAS EN LA CAJA.)

If used, return envelope in Judge's (Yellow) Bag.

If not used, leave in Ballot Carrier with unused ballots.

REGISTER OF SPOILED BALLOTS

I, the undersigned, Presiding Judge of the election named herein, do hereby certify that the above and

foregoing is a true and correct Register of Spoiled Ballots for the above-mentioned election.

(Yo, el abajo firmado Juez Presidente de la elección nombrada aqui dentro, por lo presente certifico que el documento precedente

señaldo arriba es un Registro de Boletas Dañadas para la elección mencionada arriba.)

This form is used to record

spoiled ballots due to the voter

choosing not to vote or changing

parties.

Expired Code Log

.

Election: ________________ Polling Place: ______________

Date of Election:___________ Authority Conducting Election: _____________

Expired Codes are codes that were issued but never entered in the eSlate.

If USED, place in FORMS SIGNATURE ROSTER ENVELOPE. If NOT USED, leave form in Ballot Station Binder.

G:prepping elections/VC Delivery Bag Bags and Paperwork/Ballot Station Bag/Ballot Station Binder/vona expired code log

Date

Time

Processed by

Reason expired

This form is used to record expired

access codes. Codes expire after 15

minutes if they are not entered into the

voting unit. This form can be used to

help with the reconciliation.

Click on Counts and Logs to get the numbers for the

reconciliation. Be sure to click on the Provisional tab to

get that count also.

If you click on Logs, you will see the names of the voters checked in on that Kiosk. This can be used if

you need help balancing.

You will need to separate forms according to instructions and sign in all the places

that call for Judge and/or Alternate Judge, date where necessary, and complete

the top right corner of any forms that need completion.

Check time sheets to be sure all the information is complete and that all the forms

are signed by the workers and the judge. Failure to do so may result in delay in

receiving payment.

Gather the items to return to the election office:

Controller

Kiosks (with data gizzard)

Yellow Judge’s bag

Provisional ballot box

Ballot box #3

Verify that all equipment, signs, etc. have been returned to the proper location

and is ready for pickup by the election office, the polling place is returned to the

condition you found it in, and is locked according to the agreement made with the

location. Take supplies to the election office.

Fill Online, Printable, Fillable, Blank All voters in line at 7 pm are (Tom Green County) Form

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