§ Ind. Code § 3-7-18-12Written acknowledgment of application; format

Whenever an applicant completes a voter registration application under this
chapter, the office shall provide the applicant with a written acknowledgment that the
applicant has completed a voter registration application at the office. The acknowledgment:
(1) may be a detachable part of the registration form prescribed under section 3 of this
chapter; and
(2) must set forth the name and residential address of the applicant and the date that the
application was completed.