AUTHORIZATION TO SERVE AS A

CERTIFIED ELECTION MONITOR FOR THE STATE BOARD OF ELECTION COMMISSIONERS

This is to certify that ______ is a certified election monitor representing the State Board of Election Commissioners pursuant to Arkansas Code

Annotated § 7-4-101 in the ______ Election held

__, 2_ for the purpose of serving as an observer and reporting to the State Board on the conduct of the election at the ___

polling/counting location in

County, Arkansas.

Signature of the Director State Board of Election Commissioners

Date

I have been provided, read, and agree to comply with the State Board of Election Commissioners’ Rules for Appointment of Certified Election Monitors.

Signature of Certified Election Monitor

Date

Authorized by: State Board of Election Commissioners 501 Woodlane, Suite 401N Little Rock, Arkansas 72201 (501) 682-1834 (800) 411-6996