(1) On the back of each registration form (or on a separate form if an alternate electronic registration system is used), there shall be printed a ten-year voting record form substantially as follows: VOTING RECORDName of Voter YEAR PARTY General Primary Other Election Election Elections Ballot No. or Ballot No. or Ballot No. or Ballot Ballot Ballot Application Application Application Number Number Number 1971 1972 Continued for remainder of ten (10) years
(2) The year dates printed in the first column shall be changed with each year's printing of the form.