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Absentee Application

  1. 1. I am requesting, in good faith, an absentee ballot due to (check one reason):*

  2. 2. Absentee ballot(s) requested for the following election(s) :*

  3. 5. Address where you live (residence)

  4. 6/7. Address where you would like your absentee ballot mailed to.

  5. Oath*

  6. I certify that I am a qualified and a registered (and for primary, enrolled) voter; and that the information in this application is true and correct and that this application will be accepted for all purposes as the equivalent of an affidavit and, if it contains a material false statement, shall subject me to the same penalties as if I had been duly sworn.

  7. Leave This Blank:

  8. This field is not part of the form submission.