A voter must provide an affidavit from the police chief, or next in command as his designee, stating he or she is entitled to have certain information withheld from the public pursuant to M.G.L. c. 265, § 24C, in order to qualify for confidential voter registration. The form of the affidavit obtained from the police chief or his designee shall be substantially as follows:

I, (Chief or designee), (title), certify that (name of person) of (address of person) is entitled to have certain information withheld from the public under M.G.L. c. 265, § 24C.

Signed under the pains and penalties of perjury.

_____________________________________________

Name Title

_________________ Date

This affidavit shall not be a public record. The voter registration of a person who qualifies for confidential voter registration because they are entitled to have certain information withheld from the public under M.G.L. c. 265, § 24C, shall remain confidential indefinitely. Provided, however, that if the confidential voter signs a statement in the presence of the registrar that the voter no longer wants such information withheld, the voter’s name and address shall become a public record. However, if the voter’s address ofrecord has been or is a shelter, the shelter’s address shall never become a public record.