Vermont § 2555 - Provisional ballot envelopes The clerk shall deliver to each polling place on the date of the election a sufficient number of provisional ballot envelopes printed with a voter attestation

§ 2555. Provisional ballot envelopes The clerk shall deliver to each polling place on the date of the election a sufficient number of provisional ballot envelopes printed with a voter attestation

• . The attestation
  shall include: (1) A statement informing the applicant of the requirements for voter eligibility set
  forth in section 2121 of this title and space for the provisional voter to provide the information necessary for the
  town clerk to determine eligibility, including a place for the applicant to swear
  or affirm, by checking the appropriate box, that he or she meets all voter eligibility
  requirements set forth in section 2121 of this title and the signature of the provisional voter signed under penalty of perjury. In addition,
  the attestation shall include the following information: (A) The provisional voter’s place and date of birth. (B) The provisional voter’s town of legal residence. (C) The provisional voter’s street address or a description of the physical location of
  the applicant’s residence. The description must contain sufficient information so
  that the town clerk can determine whether the applicant is a resident of the town. (2) An attestation by the provisional voter that he or she submitted a properly completed
  voter application form. The attestation shall be signed by the provisional voter under
  penalty of perjury. (3) Space on the application for documentation of the town clerk’s action. (4) A statement informing the provisional voter: “If you choose to vote by provisional
  ballot, after the close of the polls, the town clerk will determine whether you meet
  all eligibility requirements. If the clerk denies your application, he or she will
  inform you that the application has been denied.” (Added 2003, No. 59, § 30, eff. June 7, 2003; amended 2015, No. 44, § 11, eff. Jan. 1, 2017; 2017, No. 50, § 36.)