A mail voter registration application form which shall require only such information as necessary to enable the appropriate county election officials to assess the eligibility of the applicant to register to vote and county and state election officials to administer voter registration and other parts of the election process. It shall include a statement that:

1. A. specifies each eligibility requirement, including citizenship;
2. B. contains an attestation that the applicant meets such requirements; and requires the signature of the applicant under penalty of perjury;
3. C. if the applicant declines to register to vote, that declination shall remain confidential and will be used for voter registration purposes only; and

4. D. that if an applicant does register to vote, the office at which the applicant submits a voter registration application will remain confidential and be used for voter registration purposes only.

   [12-15-97; Recompiled 11/30/01]