Instructions: Print this page, fill in the blanks, and fax to 413-460-3396 (no cover page needed).  If you live in Palm Beach County and have any questions you may call 561-803-3530.

If you do not know your precinct number, please leave it blank and we will determine it from your street address.

PROTEST OF ELECTION RETURNS 
TO CANVASSING BOARD

Palm Beach County, Florida

November ____, 2000

As provided in Section 102.166(1), Florida Statutes, I, ________________________ of  Palm Beach County, Florida, believe the election returns from Precinct No. ________ in the November 7, 2000 Presidential Election are erroneous. 

I hereby protest the canvass of such returns by the Palm Beach County Canvassing Board, and request that said returns be investigated, examined, checked, and corrected by said Canvassing Board. The basis for this protest is that the selections appearing on the November 7, 2000 Presidential Election ballot were confusing and, as a result, I believe that I mistakenly cast my vote for Pat Buchanan instead of Al Gore. 

Under penalties of perjury, I swear (or affirm) that I have read the foregoing and that the facts alleged are true, to the best of my knowledge and belief. 

______________________     __________________________

Signature                Date          Printed Name  

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Street Address

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City, State, Zip Code

______________________     

Home Phone                                     

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E-mail