APPENDIX MODERATOR'S RETURN The Documents In This Section Will Constitute The Moderator's Return For The Towns Using The Marksense Voting Machine. They Replace All Forms Used With The Lever Voting Machines. The Moderator's Return Will Consist Of The Following Documents: 1. The Moderator's Statement Of Receipt (Page 48) 2. Report of Pre-Election Testing (Page 49) 3. The Election Official s Receipt For Ballots And Tabulator Can be eliminated if you have temporary storage (Page 50) 4. The Moderator's Receipt For Ballots And Tabulator (Page 51) 5. The Certificate For Opening The Polls (Page 52) 6. The Certificate For Closing Of The Polls (Page 53) 7. Ballot Log Worksheet (Page 54) 8. Official Checkers Certificate (Page 55) 9. Tally Sheet(S) (Listing Candidates And Questions) (Two Different Optional Formats) (Page 56-57) 10. Certificate For Ballot Count (Page 58) 11. Write-In Ballots For Registered Write-In Candidates (Page 59) This Moderator's Return does not have to be Prepared In Duplicate. The, with the long machine tape including the opening totals printed before the polls opened and the closing totals printed after the polls closed, should be attached to the tally sheet and returned by the polling place moderator to the Registrar Of Voters together with the Materials that the Registrars have asked you to bring back.. A copy of the tape produced at the opening and close of the polls, should be Placed and hanging on the wall for people to see sealed in where you are told to put the used ballots. 1
MODERATOR'S STATEMENT OF RECEIPT To be completed and signed by the Moderator After the close of the polls I hereby certify that I appeared not later than 8 pm of the day before the Election, Primary, or Referendum & received: 1) A Moderator s Return (which includes) copy of the report of pre-election testing prepared by the Registrars Of Voters - showing all numbers, seals & that the memory card has been locked Inside the Tabulator; 2) Keys to all Tabulators that I am responsible for; 3) All necessary supplies to conduct the Election, Primary or Referendum, that have not previously been delivered.... Moderator ----------------------------------------------------------------------------------------------------------------------------------------- REPORT OF PRE-ELECTION TESTG Town Date: Polling Place 1. We, the undersigned Registrars Of Voters and other persons present, certify that pre-election testing was conducted on the following voting machine tabulators: On Date: 2. That each machine was test voted with sample ballots and was found to be working properly. 3. We further certify that the candidate, question and public counters produced a zero tape after such pre-election testing. 4. That the seals on the back ports & on the side of the Tabulators are intact. Carrying Case Tabulator Memory Card Tabulator Port 1 Tabulator Port 2 Tabulator Side Seal #_ Serial # Seal # Seal # Seal # Seal # Registrars of Voters Registrars of Voters Received: Municipal Clerk: 2
Election Officials Receipt For Ballots And Tabulator Town Of: Date Of Election Or Primary: Voting District: We, the election officials assigned to the above named voting district for this election do hereby acknowledge receipt from the Registrars Of Voters: tabulator whose label shows it is for the following voting district: (serial # of tabulator) (# of voting district) The seal on the carrying case containing the tabulator is intact and bears the seal number (# of seal) packages of ballots. (# of packages) That each package of ballots bears a label for the above voting district If a second Tabulator is available for use : tabulator whose label shows it is for the following voting district: (serial # of tabulator) (# of voting district) The seal on the carrying case containing the tabulator is intact and bears the number (# of seal) We, further certify that upon receipt of such materials we delivered them (1) directly to the moderator of our assigned polling place, if received on election day morning or (2) directly to the designated secure location for that polling place, if received at a time other than election day morning. Date: Time: Signed: Election Official Date: Time: Signed: Election Official To be used only if a police officer has been designated to deliver equipment and ballots: Date: Time: Signed: Police Officer Keep one copy with the Moderator s Return: one copy with the Election Officials / Police Officer: 3
Moderator's Receipt For Ballots And Tabulator Town Of: Date Of Election Or Primary: Voting District: I, the Moderator assigned to the above named voting district for this Election do hereby acknowledge receipt from the Election Officials (or Police Officer): tabulator whose label shows it is for the following voting district: (serial # of tabulator) (# of voting district) The seal on the carrying case containing the tabulator is intact and bears the seal number : (# of seal) unopened packages of ballots. (# of packages). If a second Tabulator is available for use : tabulator whose label shows it is for the following voting district: (serial # of tabulator) (# of voting district) The seal on the carrying case containing the tabulator is intact and bears the seal number : (# of seal) Date: Time: Signed: Moderator Note: to be completed by the Moderator - upon receipt of tabulator and ballots either by opening temporary storage or from the Election Officials or Police Officer before the polls open. Keep one copy with the Moderator s Return: one copy with the Election Officials / Police Officer 4
Certificate For Opening Of The Polls Town: Date: Voting District: 1. We, the undersigned Election Officials certify before the polls opened, the tabulator delivered to the polls was the correct tabulator referenced above; and that we prepared the tabulator for voting in accordance with the opening procedures in moderator handbook - appendix D. 2. The seal located on the front of the tabulator was found it to be unbroken and the seal number was: 3. The (2) seals on the Back Ports & the (1) seal on the side of the tabulator are intact and unbroken. 4. We further certify, before the polls opened the tabulating machine was turned on and produced (3) tapes correctly stating town, date, and voting district; setting forth "ballots cast" total of "0" zero ; the name of each candidate; Write-In line; and each question on the ballot accurately states vote totals of "0" zero 5. We further certify the display on the front of the tabulator: showed the voting district number and a count of "0" zero. Moderator Assistant Registrar Assistant Registrar Certificate For Closing Of The Polls Moderator return 1. We, The Election Officials certify when the polls were closed, the voting machine tabulator was closed and secured against further voting in accordance with the closing procedures in moderator handbook appendix D. We further certify the Following: 1. The seal number on the front of the tabulator had not been broken. (seal #) 2. The (2) seals on the back ports & the (1) seal on the side of the tabulator are intact and unbroken. 3. The Moderator fed all remaining ballots that were eligible to be counted into the tabulator for processing. If absentee ballots were counted at the polls, the number of absentee ballots which could be and were machine processed in whole or in part was. 4. After all ballots which could be fed into the tabulator were processed, the number on the public counter (on the front of the machine) was. 5. We produced an (3) (Tapes) "Election Results Report" from the tabulator. 6. Any ballots which could not be processed by the tabulator and any ballots containing write-in votes were hand counted by the two Assistant Registrars of Voters Officials. 7. All vote totals were recorded on the tally sheet and final vote totals for each candidate and question were announced to the public by the Moderator. 8. The ballot transfer case is sealed with seal #. (# on seal) Moderator Assistant Registrar Assistant Registrar 5
Ballot Log Worksheet Town: Date: Voting District: 1. number of ballot packages received at the opening of the polls: 2. number of ballot packages received after the opening of the polls: 3. number of ballot packages received (1+2): 4. number of ballot packages remaining unopened at the close of the polls: 5. number of ballot packages opened during the election day: 6. number of loose ballots remaining at the close of the polls: 7. number of spoiled ballots: Attest: Ballot Clerk _ Ballot Clerk ------------------------------------------------------------------------------------------------------------------------------------------------------------- Official Checkers Certificate Town: Date: Voting District: We the undersigned hereby certify the following numbers: 1. number of names on the Official Checkers List 2. number of names on the Supplemental List 3. number of names on the Presidential Ballots List 4. number of names checked on the official checklist as having voted by Ballot * 5. number of names checked on the Official Checkers List as having voted in person [this will not be the same as public counter] 6. number of names checked on the Presidential Ballots List as having voted Attest: Official Checker Assistant Registrar Official Checker Assistant Registrar 6
Tally sheet Date: Town: District: Questions 1 2 3 4 5 6 7 Yes No Yes No Yes No Yes No Yes No Yes No Yes No Tabulator Tape Hand Counted Write-in Offices 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Names Tabulator Tape Hand Counted Write-in Names Tabulator Tape Hand Counted Write-in Names Tabulator Tape Hand Counted Write-in Names Tabulator Tape Hand Counted Write-in 7
Tally sheet Date: Town: District: OFFICE TABULATOR ABSENTEE TOTALS OFFICE TABULATOR ABSENTEE TOTALS OFFICE TABULATOR ABSENTEE TOTALS OFFICE TABULATOR ABSENTEE TOTALS OFFICE TABULATOR ABSENTEE TOTALS OFFICE TABULATOR ABSENTEE TOTALS OFFICE TABULATOR ABSENTEE TOTALS OFFICE TABULATOR ABSENTEE TOTALS QUESTION TABULATOR ABSENTEE TOTALS QUESTION TABULATOR ABSENTEE TOTALS YES NO YES NO 8
Only use this form for Central Counting Of s Town: Date: Voting District: Certificate For Ballot Count ================================================================================== To be completed and signed by Moderator after 8 PM ================================================================================== I hereby certify that the absentee ballot vote, including overseas ballots * set forth in this return for each candidate and for and against each question * * is correct and that the following numbers are true and accurate according to the worksheets signed by the Ballot Counters. ballots A. ballots received... B. Overseas Ballots * received (if applicable)... C. Presidential Ballots * * received (if applicable)... D. ballots received... E. ballots counted by machine... F. Ballots counted by hand (completely)... G. ballots counted... H. ballots rejected.... attest: Moderator 9
Write-In Votes For Registered Write-In Candidates* Town: Vernon Date: + Voting District: If more space needed, attach & sign additional sheets like this form Candidate name Office Machine vote (includes absentee ballots if no central counting) ballot vote (if central counting) Moderator 10