Ballot Signature Cure Form

SIGNATURE CURE AFFIDAVIT — HELP US COUNT YOUR BALLOT

During ballot verification, we found an issue with the signature on your vote-by-mail ballot (for example, the return envelope was not signed, or the signature did not reasonably match the signature we have on file). Utah law allows you to cure—or fix—this issue by completing and signing this affidavit.

By returning this form by the required deadline, you are verifying your identity and confirming that you voted the ballot, which allows election officials to count your vote.

Voter ID Number provided on the Cure Letter Notice (If Available)

Name*

First NameMiddle NameLast NameSuffix

Date of Birth*

I will provide which of the following:*

Utah Driver's License NumberLast 4 digits of my Social Security Number

Utah Driver's License Number*

A minimum of 9 digits is required

Last 4 of Social Security Number*

Did you return your voted ballot?*

YesNo. If you select no, this ballot will NOT be counted.

By signing this affidavit, you are stating under penalty of law: you are a registered voter qualified to vote in the precinct in which you are registered; this ballot belongs to you; you voted this ballot; and you are not a convicted felon currently incarcerated for the commission of a felony. The ballot will not be counted if the signature on the affidavit does not match the signature on file with the Clerk's office for the individual to whom the ballot was sent. By signing this affidavit, you authorize the Lieutenant Governor’s and County Clerk’s use of the signature on the affidavit for voter identification purposes.

Optional:

I am a voter with a qualifying disability under the Americans with Disabilities Act that impacts my ability to sign my name consistently. I can provide appropriate documentation upon request.