A. At a minimum, the following information shall be printed on the outer envelope for a provisional paper ballot:
(1) the name and signature of the voter;
(2) the voter's registered address, both present and former if applicable;
(3) the voter's date of birth;
(4) the reason for using the ballot;
(5) the precinct and the polling place at which the voter has voted; and
(6) sufficient space to list the disposition of the ballot after review by the county clerk.
B. A provisional paper ballot shall not be rejected for lack of the information required by this section and shall be qualified as long as the voter provides a valid signature and sufficient information for the clerk to determine the voter is a qualified elector.