HomeMy WebLinkAboutDocumentation_Miscellaneous_Tab 16_03/15/2016 DESIGNATION OF POLL WATCHERS FOR:
S ecif A licable Election
Pursuant to Section 101.131, Florida Statutes, I request that the following persons (none of whom is a candidate
or a sheriff, deputy sheriff, police office or other law enforcement officer), who are qualified and registered
voters of the county in which they will serve, be approved as poll watchers for (check only one):
� EARLY VOTING !'Y ELECTION DAY
1. Printed Name: Date of Birth (mm/dd/yy):
Address:
Location of Polling Room or Early Voting Site:
2. Printed Name: Date of Birth (mm/dd/yy):
Address:
Location of Polling Room or Early Voting Site:
3. Printed Name: Date of Birth (mm/dd/yy):
Address:
Location of Polling Room or Early Voting Site:
4. Printed Name: Date of Birth (mm/dd/yy):
Address:
Location of Polling Room or Early Voting Site:
NOTE: If more lines are needed to designate poll watchers, use DS-DE 125 continuation page(s) and attach to
this page. Only sign this top form, but the page count entry must be completed on the bottom of this page.
*****��x�*�*�����*���*�������:�:�:�����x�*****�x****��**�*�*****�*�**�x******�x*****�***��***���x�
Check applicable boz and fill in the blank lines:
� I am a candidate for in this election.
� I am the chair of the County Executive Committee of the Party.
� I am the chair of Political Committee.
Printed Name Signature Date
Address Phone
Attention This form is due to the Supervisor of Elections:
• For Early Voting, no later than noon of the 14 day before early voting begins.
• For Election Day, before noon of the second Tuesday preceding the election.
(This form becomes a public record when submitted to the Supervisor of Elections.)
Page 1 of pages.
DS-DE 125 (rev. OS/2011)
DESIGNATION OF POLL WATCHERS — Continuation Page
(Enter Page Number on Bottom of Page)
This form becomes a public record when submitted to the Supervisor of Elections.
1. Printed Name: Date of Birth (mm/dd/yy):
Address:
Location of Polling Room or Early Voting Site:
2. Printed Name: Date of Birth (mm/dd/yy):
Address:
Location of Polling Room or Early Voting Site:
3. Printed Name: Date of Birth (mm/ddlyy):
Address:
Location of Polling Room or Early Voting Site:
4. Printed Name: Date of Birth (mm/ddlyy):
Address:
Location of Polling Room or Early Voting Site:
5. Printed Name: Date of Birth (mm/dd/yy):
Address:
Location of Polling Room or Early Voting Site:
6. Printed Name: Date of Birth (mm/dd/yy):
Address:
Location of Polling Room or Early Voting Site:
7. Printed Name: Date of Birth (mm/dd/yy):
Address:
Location of Polling Room or Early Voting Site:
8. Printed Name: Date of Birth (mm/dd/yy):
Address:
Location of Polling Room or Early Voting Site:
9. Printed Name: Date of Birth (mmldd/yy):
Address:
Location of Polling Room or Early Voting Site:
DS-DE 125 — continuation qage (rev. OS/20111 Pa¢e