.04 Applications—Required Affidavit.

A. The application shall contain an affidavit, signed by the applicant, in substantially the following form:

Under the penalties of perjury, I declare that no part of any list requested by this application is intended to be used for commercial solicitation or for any other purpose that is not related to the electoral process.

I am aware that if I or any other person who has a registration list under his or her control knowingly allows any part of that list to be used for commercial solicitation or for any other purpose that is not related to the electoral process, that individual is guilty of a misdemeanor and, on conviction, subject to imprisonment for not less than 30 days or more than 6 months, to a fine of up to $250, or to both imprisonment and fine.

B. If the applicant submits the application online, the applicant shall use one of the following as the applicant’s electronic signature:

(1) Applicant’s driver’s license number; or

(2) Applicant’s last four digits of the applicant’s Social Security number.