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All persons filing election protests with 8 county board of election shall use the following form:
ELECTION PROTEST.
(Use ofthis form is required by GS. 163-182.5(6))
‘This form must be filed with the county bord of elections within the timeframes ston in GS, 163-1829 (by). Please pint
‘ortype your answers. Feel free to use and attach aditional sheets if needed to fully answer the questions betow. You may
‘also attach relevent exhibits and documents. Plesse number the pages of such addtional sheets and stachments
Full name and malin nddres of person ling the protest
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Z Tite date, iestion, ond exact ature ofthe lection protested. Name al caeidotes in he election andthe mmber of
ach receved. Note wining caniat(seeled or nominated.
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desorption of such misconduct or iregulaity and name thse who commited such action.
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7, Pleas et ont al leton ls or epualons tat youallege werd vile In your responses 5 or Gabove. Satehow °°
cach violation occured, Plesse provide the names, adresses, and phono numbers of those who you allege committed such
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wel out By you fb sufficient to Have fected or cast doubt upon the reslis ofthe
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protested election? If your answer ies, please slate the factual basis for your opinion.