Load CSV File of
|
|
Moderator's Return
We, the undersigned election or primary officials, certify that the required training was administered to us by the Registrars and Head Moderator at the time and place listed below, and that we received the following oath from the Moderator before commencing with our duties at the above-listed election or primary.
| Position | Name | Training Date / Time | Election Sign In Time | Election Sign Out Time | Signature | |
|---|---|---|---|---|---|---|
| Location of Pollworker Training |
We have instructed the above-listed officials as to the use of the tabulator and of their duties at this election or primary.
|
_____________________________ Registrar Signature |
_____________________________ Registrar Signature |
_____________________________ Head Moderator Signature |
|
I administered the oath to the above-listed election / primary officials at the “Start Time” listed above.
|
"You solemnly swear (or affirm, as the case may be) that you will faithfully discharge, according to law, your duties as ...., to the best of your ability; and that you will serve in this election or primary as the case may be, as an official, completely impartial with respect to any candidate or any political party; so help you God." |
Moderator's Return
| Carrying Case Seal # | Memory Card Seal # | Machine Serial # | Side Seal # | Port Seal 1 | Port Seal 2 | |
|---|---|---|---|---|---|---|
We, the undersigned Registrars of Voters and other persons present, certify that pre-election testing was conducted on the following voting tabulators at the following date and time, and that each tabulator was test voted with sample ballots and found to be working properly. We further certify that the memory cards were sealed into the tabulators and were set in "Election Mode" after such pre-election testing, with an initial ballots cast and vote total of "0."
| _____________________________
Registrar Signature |
_____________________________
Registrar Signature |
| _____________________________
Signature |
_____________________________
Signature |
_____________________________
Signature |
| _____________________________
Signature |
_____________________________
Signature |
_____________________________
Signature |
Moderator's Return
We, the undersigned Officials, being duly sworn, depose and say that we delivered the following in accordance with the Early Voting Plan:
Moderator's Return
| Tabulator Carrying Case Seals | Tabulator Memory Card Seal(s) | Ballot Packages Received |
We, the undersigned Election Officials certify that the Moderator appeared at the office of the Registrar of Voters not later than 8 p.m. of the day before the election or primary and received a copy of the "Report for Pre-Election Tabulator & Memory Card Testing" and other supplies necessary to conduct the election or primary that were not previously delivered.
We further certify that, before the polls opened, the seals located on the tabulator were unbroken and were the same seals recorded on the "Report for Pre-Election Tabulator and Memory Card Testing," and that each tabulator in use was prepared for voting in accordance with the opening procedures in the Moderator's Handbook (Appendix 4).
We further certify that, before the polls opened, the tabulator was turned on and produced a tape correctly stating the town, state, date, voting district, offices, candidates names, and questions on the ballot; and setting forth a "write-in" line for each office group, a "ballots cast" total of "0," and a vote total of "0."
We further certify that the display on the front of the tabulator showed the voting district number and a count of "0."
We certify that, before the polls opened, the ballot packages and tabulator(s) listed above were received from the Registrars of Voters and delivered to the polling place or secure storage area, and bore labels for the voting district and town referenced above.
|
_____________________________ Moderator Signature |
_____________________________ Assistant Registrar Signature |
_____________________________ Assistant Registrar Signature |
Moderator's Return
You may use the following pages to keep notes pertaining to the election.
Moderator's Return
Total number of names on the official check list at the close of the polls (including all names on the supplemental list, and excluding those who were removed from the list)
Total number of names marked as voting in person at the polls
Total number of names marked as voting absentee
Total number of names marked as voting early (including Same Day Registration voters during the early voting period)
Total number of names marked as voting at Same Day Registration on the day of the election
Total number of military voters
Total number of overseas ballot voters
Total number of Presidential ballot voters
Official Check List Total
Checked as Voting
|
_____________________________ Assistant Registrar Signature |
_____________________________ Assistant Registrar Signature |
|||
| _____________________________
Official Checker Signature |
_____________________________
Official Checker Signature |
Moderator's Return
Total number of ballot packages received
Total number of ballot packages unopened at the close of the polls
Total number of loose ballots remaining at the close of the polls
Total number of challenged ballots issued
Total number of spoiled ballots
Total number of abandoned ballots
|
_____________________________ Ballot Clerk Signature |
_____________________________ Ballot Clerk Signature |
Moderator's Return
Number of Absentee Ballots
Number of Early Voting Ballots
Number of Same Day Registration Ballots
Number of Military Ballots
Number of Overseas Ballots
Number of Presidential Ballots
Total Number of Absentee, Early, and Same Day Registration Ballots
| _____________________________
Moderator Signature |
Moderator's Return
We, the undersigned Election Officials certify that after the polls were closed, the voting tabulator was closed and secured against further voting in accordance with the closing procedures in the Moderator’s Handbook, Appendix 4.
We further certify that the memory card seal on the front of the tabulator had not been broken.
We further certify that the Moderator fed all remaining ballots that were eligible to be counted by tabulator into the tabulator for processing.
We further certify that the tabulator thereupon produced an “Election Results Report” setting forth: the town, voting district, election date and vote totals for each candidate and question on the ballot.
We further certify that any ballots which could not be processed by the tabulator and any ballots containing write-in votes were hand counted by two election officials from different parties or returned to the Head Moderator for counting as indicated below.
We further certify that the number on the public counter after all ballots that could be fed into the tabulator were processed, the number on the seals applied to the ballot transfer case(s) and tabulator carrying case(s), and the number of absentee, early voting, and same day registration ballots (if counted at this location) which were tabulator processed in whole or in part are as recorded below.
Once all votes for each candidate and question have been counted either by tabulator or by hand all vote totals were recorded on the tally sheet and all final vote totals for each candidate and question were announced by the Moderator to all those present.
| Tabulator Memory Card Seals | Tabulator Carrying Case Seals | ||
| Ballot Transfer Case Seal(s) | Number of Ballots in the Write-In Bin | Number of Ballots in the Auxiliary Bin after Processing | |
| Ballots Read by Tabulator at the Close of the Polls
|
Auxiliary Bin Ballots were processed by:
|
||
|
_____________________________ Moderator Signature |
_____________________________ Assistant Registrar Signature |
_____________________________ Assistant Registrar Signature |
Moderator's Return
| Candidate Name |
Ballot Position |
|---|
| Tabulator | Hand
Count |
Write-In | Total |
|---|
Moderator's Return
Please fold and attach the first results tape printed from the tabulator to this page.
It should be connected (unbroken) to the zero results report that was signed before the opening of the polls, and then signed again following those results.
Please also be sure to include one signed zero tape and one signed results tape in the ballot transfer case before sealing it at the end of the day.