The City Clerk shall provide a return envelope with each official early ballot. The City Clerk’s name or title and address shall be stamped or printed on one side of the envelope and on the other side of the envelope shall be stamped or printed an affidavit in substantially the following form:

I, the undersigned voter, do solemnly swear that I am a qualified elector of the State of Arizona and the County of Maricopa, residing in the City of Phoenix, in the District indicated below, and entitled to vote in this election.

I further swear that I personally voted the enclosed ballot (or that it was voted according to my instruction because I was unable to do so) and that if I did not personally sign it was because of physical disability and that I requested (Name of person signing affidavit) to sign my name for me.

I understand that knowingly voting more than once in any election is a Class 5 felony.

If a challenge is filed against my early ballot, I understand that a copy of the challenge will be sent to me by first class mail and that I may have as little as forty-eight hours notice of an opportunity to appear. For purposes of notifying me of a ballot challenge between the time I return the early ballot and seven days after the election, please use the following address: ____________. (If no address is provided, notice will be mailed to the mailing address listed on the registration rolls.)