§ Ind. Code § 3-11-4-21Envelope; affidavit

(a) On the other side of the envelope required by section 20 of this chapter shall
be printed an affidavit in conformity with 52 U.S.C. 20302(b) and with the name of the
precinct completed by the county election board, providing that the voter affirms under
penalty of perjury that the following information is true:
(1) That the voter is:
(A) a resident of; or
(B) entitled under IC 3-10-11 or IC 3-10-12 to vote in;
the precinct.
(2) The voter's complete residence address, including the name of the city or town and
county.
(3) That the voter is entitled to vote in the precinct, the type of election to be held, and
the date of the election.
(4) That:
(A) the voter has personally marked the enclosed ballot or ballots in secret and has
enclosed them in this envelope and sealed them without exhibiting them to any other
person; or
(B) the voter personally marked the enclosed ballot or ballots, enclosed them in this
envelope, and sealed them with the assistance of an individual whose name is listed
on the envelope and who affirms under penalty of perjury that the voter was not
coerced or improperly influenced by the individual assisting the voter or any other
person, in a manner prohibited by state or federal law, to cast the ballot for or against
any candidate, political party, or public question.
(5) The date and the voter's signature.
(b) The side of the envelope containing this affidavit must also set forth the penalties for
perjury.