NO. 134. AN ACT RELATING TO ADDRESS CONFIDENTIALITY FOR VICTIMS OF DOMESTIC VIOLENCE, SEXUAL ASSAULT AND STALKING.

(H.807)

It is hereby enacted by the General Assembly of the State of Vermont:

Sec. 1. DESIGNATION

15 V.S.A. chapter 21, §§ 1101 through 1115 are designated as:

Subchapter 1. General Provisions

Sec. 2. 15 V.S.A. chapter 21, subchapter 3 is added to read:

Subchapter 3. Address Confidentiality for Victims of Domestic

Violence, Sexual Assault or Stalking

§ 1150. FINDINGS AND INTENT

(a) The general assembly finds that persons attempting to escape from actual or threatened domestic violence, sexual assault and stalking frequently establish new addresses in order to prevent their assailants or probable assailants from finding them.

(b) It is the purpose of this subchapter to:

(1) enable state and local agencies to respond to requests for public records without disclosing the location of a victim of domestic violence, sexual assault or stalking;

(2) promote interagency cooperation with the secretary of state in providing address confidentiality for victims of domestic violence, sexual assault and stalking; and

(3) enable state agencies and local agencies to accept a program participant's use of an address, and local agencies to accept an address, designated by the secretary of state as a substitute mailing address.

§ 1151. DEFINITIONS

Unless the context clearly requires otherwise, the definitions in this section apply throughout the subchapter.

(1) “Address” means a residential street address, school address, post office box address or work address of an individual, as specified on the individual's application to be a program participant under this chapter.

(2) “Domestic violence” means an act of abuse as defined in subdivision 1101(1) of this title and includes a threat of such acts committed against an individual in a domestic situation, regardless of whether these acts or threats have been reported to law enforcement officers.

(3) “Program participant” means a person certified as a program participant under this chapter.

(4) “Sexual assault” means an act of assault as defined in subsection 3252(a) or (b) of Title 13 (sexual assault) or in subsection 3253(a) of Title 13 (aggravated sexual assault), and includes a threat of such acts, regardless of whether these acts or threats have been reported to law enforcement officers.

(5) “Stalking” means conduct as defined in section 1061(stalking) or in section 1063 of Title 13 (aggravated stalking), and includes a threat of such acts, regardless of whether these acts or threats have been reported to law enforcement officers.

§ 1152. ADDRESS CONFIDENTIALITY PROGRAM; APPLICATION;

CERTIFICATION

(a) An adult person, a parent or guardian acting on behalf of a minor, or a guardian acting on behalf of an incapacitated person, may apply to the secretary of state to have an address designated by the secretary serve as the person's address or the address of the minor or incapacitated person. The secretary of state shall approve an application if it is filed in the manner and on the form prescribed by the secretary of state, and if it contains:

(1) a sworn statement by the applicant that the applicant has good reason to believe:

(A) the applicant, or the minor or incapacitated person on whose behalf the application is made, is a victim of domestic or sexual violence-related or stalking-related behavior; and

(B) the applicant fears for his or her safety or his or her children's safety, or the safety of the minor or incapacitated person on whose behalf the application is made;

(2) a designation of the secretary as agent for purposes of service of process and for the purpose of receipt of mail;

(3) the mailing address where the applicant can be contacted by the secretary and the phone number or numbers where the applicant can be called by the secretary;

(4) the new address or addresses that the applicant requests not be disclosed for the reason that disclosure will increase the risk of domestic violence, sexual assault or stalking;

(5) the signature of the applicant and of any individual or representative of any office who assisted in the preparation of the application, and the date on which the applicant signed the application.

(b) Applications shall be filed with the office of the secretary.

(c) Upon receipt of a properly completed application, the secretary shall certify the applicant as a program participant. Applicants shall be certified for four years following the date of filing, unless the certification is withdrawn or invalidated before that date. The secretary shall by rule establish a renewal procedure.

(d) A person who falsely attests in an application that disclosure of the applicant's address would endanger the applicant's safety, or the safety of the applicant's children or the minor or incapacitated person on whose behalf the application is made, or who knowingly provides false or incorrect information upon making an application, shall be punishable in accordance with the criminal penalties for perjury as described in section 2901 of Title 13.

(e) A program participant shall notify the secretary of state of a change of address within seven days of the change of address.

§ 1153. CERTIFICATION CANCELLATION

(a) The secretary of state may cancel a program participant’s certification if, after the passage of 14 days:

(1) from the date of changing his or her name, the program participant does not notify the secretary that he or she has obtained a name change; however, the program participant may reapply under his or her new name;

(2) from the date of changing his or her address, the program participant fails to notify the secretary of the change of address; or

(3) from the date the secretary first receives mail, forwarded to the program participant's address, returned as nondeliverable.

(b) The secretary shall cancel certification of a program participant who applies using false information.

(c) The secretary shall send notice of termination to the program participant. Notice of termination shall set out the reasons for termination. The program participant shall have 30 days to appeal the termination decision under procedures developed by the secretary.

(d) Program participants may withdraw from the program by giving the secretary written notice of their intention. The secretary shall establish, by rule, a secure procedure for ensuring that the request for withdrawal is legitimate.

§ 1154. AGENCY USE OF DESIGNATED ADDRESS

(a) A program participant shall request that state and local agencies use the address designated by the secretary of state as the participant’s address. When creating a new public record, state and local agencies shall accept the address designated by the secretary as a program participant's substitute address, unless the secretary has determined that:

(1) the agency has a bona fide statutory or administrative requirement for the use of the address which would otherwise be confidential under this subchapter;

(2) the address will be used only for those statutory and administrative purposes;

(3) the agency has identified the specific program participant’s record for which the waiver is requested;

(4) the agency has identified the individuals who will have access to the record; and

(5) the agency has explained how its acceptance of the substitute address will prevent the agency from meeting its obligations under the law and why it cannot meet its statutory or administrative obligation by a change in its internal procedures.

(b) During the review, evaluation, and appeal of an agency’s request, the agency shall accept the use of a program participant’s substitute address.

(c) The secretary’s determination to grant or withhold a requested waiver must be based on, but not limited to, an evaluation of the information under subsection (a) of this section.

(d) If the secretary finds that the agency has a bona fide statutory and administrative need for the actual address and that the information will only be used for that purpose, the secretary may issue the actual address to the agency. Prior to granting the waiver, the secretary shall notify the program participant of the waiver, including the name of the agency and the reasons for the waiver. When granting a waiver, the secretary shall notify and require the agency to maintain the confidentiality of the program participant’s address and designate a date after which the agency no longer maintains the record of the address.

(e) Denial of the agency waiver request must be made in writing and include a statement of the reasons for denial.

(f) Acceptance or denial of the agency’s waiver request constitutes final agency action. An aggrieved party may appeal. The secretary shall adopt rules establishing an appeal process.

(g) A program participant may use the address designated by the secretary as his or her work address.

(h) The office of the secretary shall forward all first class mail to the appropriate program participants.

(i) The secretary shall keep a record of all waivers and all documentation relating to requests for waivers.

(j) Any agency receiving a waiver may not make the program participant’s address available for inspection or copying, except under the following circumstances:

(1) if requested by a law enforcement agency for purposes of assisting in the execution of an arrest warrant; or

(2) if directed by a court order to a person identified in the order.

§ 1155. DISCLOSURE OF ADDRESS PROHIBITED; EXCEPTIONS

(a) The secretary of state may not make a program participant's address, other than the address designated by the secretary, available for inspection or copying, except under the following circumstances:

(1) if requested by a law enforcement agency for purposes of assisting in the execution of an arrest warrant;

(2) if directed by a court order to a person identified in the order;

(3) to verify the participation of a specific program participant, in which case the secretary may only confirm information supplied by the requester; or

(4) if certification has been canceled.

(b) The secretary shall provide immediate notification of disclosure to a program participant when disclosure takes place under subdivisions (a)(2) and (3) of this section.

§ 1156. NONDISCLOSURE OF ADDRESS IN CRIMINAL AND CIVIL

PROCEEDINGS

No member of the department of state’s attorneys, victim’s advocate, law enforcement agency, local social service agency or witness shall be compelled to disclose the program participant’s actual residential address or place of employment during the discovery phase of, or during testimony in any criminal or civil proceeding unless the court finds, based on a preponderance of the evidence, that nondisclosure will prejudice the defendant.

§ 1157. ASSISTANCE FOR PROGRAM APPLICANTS

The secretary of state shall make available a list of state and local agencies and nonprofit agencies that provide counseling and shelter services to victims of domestic violence, sexual assault and stalking to assist persons applying to be program participants. Such information provided by the office of the secretary or designees to applicants shall in no way be construed as legal advice.

§ 1158. VOTING BY PROGRAM PARTICIPANT

A program participant who is otherwise qualified to vote may register to vote and apply for an absentee ballot pursuant to rules adopted by the secretary of state under section 1160 of this title. Such rules shall enable a town clerk to substitute, on all voting records of the town, the designation “blind ballot” wherever the name or address of the voter might otherwise appear. The program participant shall receive absentee ballots for all elections in the jurisdictions for which that individual resides in the same manner as absentee voters who qualify under section 2531 of Title 17. The town clerk shall transmit the absentee ballot to the program participant at the address designated by the participant in his or her application. Neither the name nor the address of a program participant shall be included in any list of registered voters available to the public.

§ 1159. CUSTODY AND VISITATION ORDERS

Nothing in this chapter, nor participation in this program, affects custody or visitation orders in effect prior to or during program participation.

§ 1160. ADOPTION OF RULES

The secretary of state shall adopt rules necessary to perform his or her duties under this subchapter relating to: program application and certification; certification cancellation; agency use of designated addresses and exceptions; voting by program participants; and recording of vital statistics for program participants. All such rules shall conform with the findings and intent of the general assembly, as described in section 1150 of this title, and shall be designed with an understanding of the needs and circumstances of victims of domestic violence, sexual assault and stalking.

Sec. 3. 1 V.S.A. § 317(c) is amended to read:

(c) The following public records are exempt from public inspection and copying:

* * *

(29) the address of a certified participant in the address confidentiality program described in chapter 21, subchapter 3 of Title 15, except as provided in that subchapter, during the period of certification.

Sec. 4. 18 V.S.A. § 5083 is added to read:

§ 5083. PARTICIPANTS IN ADDRESS CONFIDENTIALITY PROGRAM

(a) If a participant in the program described in chapter 21, subchapter 3 of Title 15 who is the parent of a child born during the period of program participation notifies the physician or midwife who delivers the child, or the hospital at which the child is delivered, not later than 24 hours after the birth of the child, that the participant's confidential address should not appear on the child's birth certificate, then the department shall not disclose such confidential address or the participant's town of residence on any public records. A participant who fails to provide such notice shall be deemed to have waived the provisions of this section. If such notice is received, then notwithstanding section 5071 of this title, the attendant physician or midwife shall file the certificate with the supervisor of vital records registration within ten days of the birth, without the confidential address or town of residence, and shall not file the certificate with the town clerk.

(b) The supervisor of vital records registration shall receive and file for record all certificates filed in accordance with this section, and shall ensure that a parent's confidential address and town of residence do not appear on the birth certificate during the period that the parent is a program participant. A certificate filed in accordance with this section shall be a public document. The supervisor of vital records shall notify the secretary of state of the receipt of a birth certificate on behalf of a program participant.

(c) The department shall maintain a confidential record of the parent's actual mailing address and town of residence. Such record shall be exempt from public inspection.

(d) Upon the renewal, expiration, withdrawal, invalidation or cancellation of program participation of any parent of whom the secretary of state received notice from the supervisor of vital records registration, the secretary of state shall notify the supervisor of vital records registration.

(e) Notwithstanding section 5075 of this title, upon notice of the expiration, withdrawal, invalidation or cancellation of program participation, the supervisor of vital records registration shall enter the actual mailing address and town of residence on the original birth certificate and shall transmit the completed original birth certificate to the town clerk where the birth occurred.

(f) The town clerk shall process certificates received in this manner in accordance with the provisions of this chapter.

Sec. 5. 18 V.S.A. § 5132 is added to read:

§ 5132. MARRIAGE LICENSE; PARTICIPANTS IN ADDRESS

CONFIDENTIALITY PROGRAM

(a) If a participant in the program described in chapter 21, subchapter 3 of Title 15 notifies the town that the participant's confidential address should not appear on the marriage license or certificate, then the town clerk shall not disclose such confidential address or the participant's town of residence on any public records. A participant who fails to provide such notice shall be deemed to have waived the provisions of this section. If such notice is received, then notwithstanding section 5131 of this title, the town clerk shall file the marriage certificate with the supervisor of vital records registration within ten days of receipt, without the confidential address or town of residence, and shall not retain a copy of the marriage certificate.

(b) The supervisor of vital records registration shall receive and file for record all certificates filed in accordance with this section, and shall ensure that a person's confidential address and town of residence do not appear on the marriage certificate during the period that the person is a program participant. A certificate filed in accordance with this section shall be a public document. The supervisor of vital records shall notify the secretary of state of the receipt of a marriage certificate on behalf of a program participant.

(c) The department shall maintain a confidential record of the person's actual mailing address and town of residence. Such record shall be exempt from public inspection.

(d) Upon the renewal, expiration, withdrawal, invalidation or cancellation of program participation of any person of whom the secretary of state received notice from the supervisor of vital records registration, the secretary of state shall notify the supervisor of vital records registration.

(e) Upon notice of the expiration, withdrawal, invalidation or cancellation of program participation, the supervisor of vital records registration shall enter the actual mailing address and town of residence on the original marriage certificate and shall transmit the completed original marriage certificate to the town clerk where the certificate was issued.

(f) The town clerk shall process certificates received in this manner in accordance with the provisions of this chapter.

Sec. 6. 17 V.S.A. § 2122 is amended to read:

§ 2122. RESIDENCE; SPECIAL CASES; CHECKLIST

(a) A person shall not gain or lose a residence solely by reason of presence or absence while in the service of the state or of the United States; nor while engaged in the navigation of the waters of the state or of the United States or on the high seas; nor while in a hospital, nursing home, or other health care facility; nor while confined in a prison or correctional institution; nor while a member of a veterans' home; nor while a student at any educational institution; nor while living outside the United States; nor while certified as a participant in the address confidentiality program under chapter 21, subchapter 3 of Title 15. Members of the Vermont veterans' home in the town of Bennington may vote in the town of Bennington in all elections but this right shall not affect their residence for any other purpose.

* * *

Sec. 7. 17 V.S.A. § 2126 is amended to read:

§ 2126. VILLAGE CHECKLIST

A village clerk shall automatically include on the village checklist the names of all persons living within the village who are on the checklist of the town in which the village is located, except as provided in section 2122 of this title. No separate application or other action on the part of the voter shall be required.

Sec. 8. APPROPRIATION

(a) There is appropriated from the general fund in fiscal year 2001 to the Secretary of State the amount of $17,000.00 to carry out the purposes of this act.

(b) The establishment of one (1) limited service position – Program Coordinator – in the office of the Secretary of State is authorized in fiscal year 2001.

Sec. 9. EFFECTIVE DATE

This act shall take effect on January 1, 2001.

Approved: May 12, 2000

H.476

Introduced by Committee on Government Operations

Date:

Subject: Executive branch; secretary of state; address confidentiality program

Statement of purpose: This bill proposes to:

(1) clarify application requirements;

(2) eliminate the exception for disclosure of a participant’s address when his or her certification has been cancelled;

(3) provide an exception for disclosure of a participant’s address when requested by a law enforcement agency for a legitimate law enforcement purpose; and

(4) require the secretary of state to adopt rules which ensure expeditious disclosure of participant addresses when required.

AN ACT RELATING TO ADDRESS CONFIDENTIALITY OF VICTIMS OF DOMESTIC VIOLENCE, SEXUAL ASSAULT, AND STALKING

It is hereby enacted by the General Assembly of the State of Vermont:

Sec. 1. PURPOSE

Sec. 2. 15 V.S.A. § 1151 is amended to read:

§ 1151. DEFINITIONS

Unless the context clearly requires otherwise, the definitions in this section apply throughout the subchapter.

(1) "*[Address]* Actual address" means *[a residential street address,]* the physical location where the applicant resides and may include a school address*[, post office box address]* or work address of an individual, as specified on the individual’s application to be a program participant under this chapter.

* * *

Sec. 3. 15 V.S.A. § 1152 is amended to read:

§ 1152. ADDRESS CONFIDENTIALITY PROGRAM; APPLICATION; CERTIFICATION

(a) An adult person, a parent or legal guardian acting on behalf of a minor, or a legal guardian acting on behalf of an incapacitated person, may apply to the secretary of state to have an address designated by the secretary serve as the person’s address or the address of the minor or incapacitated person. The secretary of state shall approve an application if it is filed in the manner and on the form prescribed by the secretary of state, and if it contains:

(1) a *[sworn]* statement made under oath by the applicant that *[the applicant has good reason to believe]*:

(A) the applicant, or the minor or incapacitated person on whose behalf the application is made, is a victim of domestic *[or]* violence, sexual *[violence-related]* assault, or *[stalking-related behavior]* stalking; *[and

]*

(B) the applicant fears for his or her safety or his or her children’s safety, or the safety of the minor or incapacitated person on whose behalf the application is made;

* * *

(5) the signature of the applicant and the name of any individual or representative of any office who assisted in the preparation of the application*[, ]*and the date on which the applicant signed the application.

(b) Applications shall be filed with the office of the secretary.

(c) Upon receipt of a properly completed application, the secretary shall certify the applicant as a program participant. Applicants shall be certified for four years following the date of filing, unless the certification is withdrawn or *[invalidated]* cancelled before that date. The secretary shall by rule establish a renewal procedure.

(d) A person who *[falsely attests in an application that disclosure of the applicant’s address would endanger the applicant’s safety, or the safety of the applicant’s children or the minor or incapacitated person on whose behalf the application is made, or who]* knowingly provides false or incorrect information *[upon making an application, shall]* to the secretary as required by this chapter may be *[punishable in accordance with the criminal penalties for perjury as described in]* prosecuted under section 2904 of Title 13.

(e) A program participant shall notify the secretary of state of a change of actual address within seven days of the change of address.

Sec. 4. 15 V.S.A. § 1153(c) is amended to read:

(c) The secretary shall send notice of *[termination]* cancellation to the program participant. Notice of *[termination]* cancellation shall set out the reasons for *[termination]* cancellation. The program participant shall have 30 days to appeal the *[termination]* cancellation decision under procedures developed by the secretary.

Sec. 5. 15 V.S.A. § 1154 is amended to read:

§ 1154. AGENCY USE OF DESIGNATED ADDRESS; AGENCY OTHER

(a) A program participant shall request that state and local agencies, other than law enforcement agencies, use the substitute address *[designated by the secretary of state]* as the participant’s address. When creating a new public record, state and local agencies, other than law enforcement agencies, shall accept the *[address designated by the secretary as a program participant’s]* substitute address, unless the secretary has determined that:

(1) the agency has a bona fide *[statutory or administrative]* requirement for the use of the actual address which would otherwise be confidential under this subchapter;

* * *

(d) If the secretary finds that the agency has a bona fide *[statutory and administrative need]* purpose for the actual address and that the information will only be used for that purpose, the secretary *[may]* shall issue the actual address to the agency. Prior to granting the waiver, the secretary shall notify the program participant of the waiver, including the name of the agency and the reasons for the waiver. *[When granting]* If granted a waiver, *[the secretary shall notify and require]* the agency *[to]* shall maintain the confidentiality of the program participant’s address *[and designate a date after which the agency no longer maintains the record of the address]* by redacting the actual address when the record is released to any person.

* * *

(f) Acceptance or denial of the agency’s waiver request constitutes final agency action. An aggrieved party may appeal. *[The secretary shall adopt rules establishing an appeal process.]*

* * *

(j) Any agency receiving a waiver may not make the program participant’s actual address available for inspection or copying, except under the following circumstances:

(1) if requested by a law enforcement agency for *[purposes of assisting in the execution of an arrest warrant]* a legitimate law enforcement purpose as determined by the law enforcement agency; or

(2) if directed by a court order to a person identified in the order.

Sec. 6. 15 V.S.A. § 1154a is added to read:

Sec. 7. 15 V.S.A. § 1155 is amended to read:

§ 1155. DISCLOSURE OF ADDRESS PROHIBITED; EXCEPTIONS

(a) The secretary of state may not make a program participant’s address, other than the address designated by the secretary, available for inspection or copying, except under the following circumstances:

(1) if requested by a law enforcement agency for *[purposes of assisting in the execution of an arrest warrant]* a legitimate law enforcement purpose as determined by the law enforcement agency; or

(2) if directed by a court order to a person identified in the order; or

(3) to verify the participation of a specific program participant, in which case the secretary may only confirm information supplied by the requester*[; or

(4) if certification has been canceled]*.

(b) The secretary shall ensure by rule that:

(d) The secretary shall provide immediate notification of disclosure to a program participant when disclosure takes place under subdivisions (a)(2) and (3) of this section.

Sec. 8. 15 V.S.A. § 1156 is amended to read:

§ 1156. NONDISCLOSURE OF ADDRESS IN CRIMINAL AND CIVIL PROCEEDINGS

*[

No member of the department of state’s attorneys, victim’s advocate, law enforcement agency, local social service agency or witness shall be compelled to disclose the program participant’s actual residential address or place of employment during the discovery phase of, or during testimony in any criminal or civil proceeding unless the court finds, based on a preponderance of the evidence, that nondisclosure will prejudice the defendant.]* No person shall be compelled to disclose a program participant’s actual address during a proceeding before a court of competent jurisdiction, unless the court finds, based upon a preponderance of the evidence, that the disclosure is required in the interests of justice. A court may seal that portion of any record that contains a program participant’s actual address. Nothing in this subchapter shall prevent the state from using a program participant’s actual address in any document or record filed with a court if, at the time of filing, the document or record is not a public record.

Sec. 9. 15 V.S.A. § 1161 is added to read:

Sec. 10. 1 V.S.A. § 317(c)(29) is amended to read:

(c) The following public records are exempt from public inspection and copying:

* * *

(29) the *[address]* records in the custody of the secretary of state of a *[certified]* participant in the address confidentiality program described in chapter 21, subchapter 3 of Title 15, except as provided in that subchapter*[, during the period of certification]*.

B. Definitions

1. "Actual address" means the physical location where the applicant resides and may include a school address, or work address of an individual, as specified on the individual’s application to be a program participant.
2. "Agency" means any subdivision of the state of Vermont, a municipality, or a subdivision of a municipality.
3. "Application assistant" means an employee of a state or local agency, or of a non-governmental agency or program that provides counseling, referral, or shelter services to victims of sexual assault, domestic violence, or stalking, who has been designated by their respective program, and who has been registered with the Secretary of State to assist individuals in the completion of program participation applications.
4. "Blind ballot voter" means a program participant who has applied and qualified as a voter in a town in accordance with the rules herein. The blind ballot voter’s name will not appear on a checklist and the town clerk will send absentee voter ballots to the Secretary of State’s office in accordance with the rules herein.
5. "Bona fide purpose" means a statutory or administrative requirement the agency is unable to fulfill without possession of an individual’s actual address.
6. "Cancelled" means the status of a person who is no longer certified in the SAH program.

1. Any person may apply to the Secretary to become an application assistant. If

   the request is approved by the Secretary, that person shall be designated

   by the Secretary as an application assistant. Application assistants shall provide their name and the name and phone number of the government agency or non-governmental agency or program of which they are employed or affiliated, and when appropriate, the address of the agency or program.

2. Agency or program directors shall approve employee designations prior to application assistant registration. All persons must be registered with the Secretary to serve as application assistants. Application assistants’ registrations shall be renewed annually.
3. Application assistants must be trained, and the training shall include, but is not limited to, the application process, program components, program guidelines, program limitations, and the importance of safety planning.
4. The SAH program shall provide application assistants with all necessary application materials.

   E. Application Process

   1) Prospective participants may obtain SAH applications at local domestic violence or sexual assault programs, from victim advocates, or from any other application assistant.

   2) Applicants must be given orientation information about the SAH program from an application assistant.

   3) Application assistants shall request one or more forms of identification from program applicants. Upon request by the application assistant, a program participant shall provide identification to the application assistant that establishes the applicant's identity to the satisfaction of the application assistant. In the event that a program participant cannot provide such identification due to exigent circumstances, the Secretary may temporarily approve the application absent the identification if the application is otherwise properly completed. The application shall be temporarily approved for no more than 45 days upon which the participant must provide identification to the application assistant or Secretary.

   4) A properly completed application form shall contain the following information:

   (a) the applicant’s name and date of birth, and the name and date of birth of the minor or incapacitated person on whose behalf the application is made; and

   (b) (1) a statement made by the applicant that the applicant, or the minor or incapacitated person on whose behalf the application is made, is a victim of domestic violence, sexual assault or stalking; and

        (2) a statement made by the applicant that the applicant fears for her or his safety or her or his children's safety, or the safety of the minor or incapacitated person on whose behalf the application is made; and

   (c) a designation of the Secretary as agent for purposes of service of process and for the purpose of receipt of first-class mail; and

   (d) the actual address or addresses that the applicant requests not be disclosed; and

   (e) the phone number or numbers where the applicant can be called by the Secretary; and

   (f) the name and phone number of the application assistant, and the name of the respective program or agency, and the date on which the applicant signed the application; and

   (g) the applicant’s signature; and

   (h) a signed statement that the applicant has read and understands the checklist of participant responsibilities; and

   (i) a statement made under oath that the applicant has affirmed under the penalties of perjury that the information on the application is true and accurate.

5. An application shall be considered properly completed when the application form is completed in accordance with 4) above and the following requirements are otherwise met:

F. Program Certification

1. Upon receipt of a properly completed application, the Secretary shall certify the applicant as a program participant.
2. An authorization card shall be issued within five working days after the application is received by the Secretary and the Secretary has certified the participant. The SAH program shall issue a program participant authorization card to each individual named on the completed application form. The authorization card shall include the program participant’s name, authorization code, substitute mailing address, certification expiration date, applicant’s signature, toll free number of the SAH program, and a statement that the authorization card is not a legal form of identification.
3. Applicants shall be certified for four years following the date of certification, unless the certification is withdrawn or cancelled before that date.
4. A program participant shall notify the Secretary of any change of actual address or phone number within seven days of the change.

15. Voting as Blind Ballot

1. A program participant may notify the SAH program of any request for confidentiality in voting records by requesting to exercise blind ballot voter privileges. The Secretary shall send an application to the checklist and absentee voter request form to the program participant for completion.
2. The program participant shall enter the blind ballot voter number, as provided by the Secretary, on the line for the name and enter the substitute address as the mailing address. A properly completed application to the checklist and absentee voter request form shall be received by the SAH program by the third Saturday prior to any election. If the program participant was not previously registered to vote in Vermont, the voters oath must be administered by a notary and subscribed on the registration form.
3. The Secretary shall consult with the town clerk to determine the proper district where the participant resides for voting purposes. The Secretary shall sign an affirmation of the program participant’s residency in the town and district.
4. The SAH program shall keep a copy of all applications and shall send to the clerk of the town where the participant resides: 1) a copy of the absentee voter request form omitting any information intended to be confidential, 2) the application to the checklist omitting any information intended to be confidential, and 3) the Secretary’s affirmation of residency. Town clerks shall not have access to the confidential information of program participants.
5. The town clerk shall include blind ballot voters on the checklist by using blind ballot numbers and the substitute address in lieu of the voters’ actual names and addresses.
6. The SAH program shall send the form authorizing removal from previous town checklists to the previous town clerk.
7. Not later than 30 days prior to the election, or within 1 day of receipt of a request for absentee ballots if the request is less than 30 days before the election, the town clerk will send the absentee voting ballots to the SAH program who will forward them to participants at their actual addresses.