The certification of provisional ballot count shall be a table containing the following elements:

1. (1) Precinct Name;
2. (2) Name of candidate or ballot question;
3. (3) Number of votes received in figures; and

4. (4) Number of votes received in words.

   The certification shall also contain the following:

   STATE OF SOUTH DAKOTA )

   ) SS

   COUNTY OF _____________ )

   We (listnames), appointed as the provisional ballot counting board or provisional ballot resolution board in the jurisdiction of __________ for the ________________ election held on the ____ day of _______________, 20 _____, hereby certify that the foregoing is a true abstract of the provisional votes which were counted for this jurisdiction.

   _____________________________

   _____________________________

   _____________________________

   _____________________________

   _____________________________

   Sworn to before me this _______ day of _______________, 20_____.

   ________________________

   Person in Charge of the Election

Source: 29 SDR 177, effective July 2, 2003.

General Authority: SDCL 12-20-13.1.

Law Implemented: SDCL 12-20-13.1.