721—22.19 (52) Examination of voting booths—application. Any vendor who wishes to apply for approval of a voting booth for use in the state of Iowa shall apply to the secretary of state for an appointment with the examiners. The application shall include five copies of each of the following:
	 22.19(1) History of the voting booth to be examined. This history shall include a complete description of the voting booth to be examined, descriptions of any previous models of the voting booth, the date the voting booth to be examined went into production, and a list of jurisdictions which have used the voting booth.
	 22.19(2) Copies of all manuals developed for use with the voting booth including, but not limited to, technical manuals for repair and maintenance of the voting booth, assembly manuals for election officials, and any other written documents prepared by the vendor that describe the operation, use and maintenance of the voting booth.
	 22.19(3) Copies of the reports of any test authority who has examined the voting booth in conjunction with certification requirements of other states.
	 22.19(4) Reports of the certifying authorities of any other states who have examined the voting booth, whether or not the voting booth was approved for use.
	 22.19(5) Brochures, photographs and advertising material used to encourage sales of the voting booth.
	 22.19(6) Manuals for the use and maintenance of any components of the voting booth that are not manufactured by the vendor.
	 22.19(7) A list of jurisdictions using the booth.
	 22.19(8) Request for examination. The following form shall be filed with the materials required above:
STATE OF IOWA
REQUEST FOR EXAMINATION OF VOTING BOOTH
BY THE BOARD OF EXAMINERS FOR VOTING MACHINES
AND ELECTRONIC VOTING SYSTEMS
Name of model(s) to be examined:  	
Vendor or Commissioner:  	
Address:  	
City, State, Zip:  	
Telephone number:  	
Person to contact:  	
I request that the Iowa Board of Examiners for Voting Machines and Electronic Voting Systems examine the voting booth(s) described above and in the attached documents for the purpose of determining whether this voting booth will be approved for use in the State of Iowa. If required to do so, I will pay the costs of this examination, including the examiners’ fees and expenses. I understand that the examiners’ fee of one hundred fifty dollars ($150) each is to be paid before the examination begins. If more than one vendor presents booths to be examined, I understand that the examiners’ fees will be divided equally among the vendors. (Fees shall be waived for examination of voting booths for county commissioners.)
I understand that a production model of the voting booth submitted for certification shall be made available to the examiners.
I agree to submit subsequent models of this voting booth for further examination if any changes are made following its approval for use. I understand that certification will be denied or rescinded if the examiners determine that this voting booth does not meet the requirements of the Code of Iowa and Iowa Administrative Code.
I understand that voting booths that have not been approved by the examiners cannot be used at any election in the State of Iowa.
Signed:  	
Title:  	
State of  	
County of  	
Signed and sworn to (or affirmed) before me on _____________________(date)
by  	 .
	
NOTARY PUBLIC (or title of other officer
authorized to perform notarial acts)