This form may be submitted by mail, fax or email to your county election commission. When emailing, you must
attach the completed request to the email. Click here
to find contact information for your election commission.
First Day to accept a Request: MAY 8, 2020 Last Day to accept a Request: JULY 30, 2020
PROVIDE ALL OF THE INFORMATION BELOW (REQUIRED)
PRINT FULL LEGAL NAME:
ADDRESS WHERE YOU LIVE:
CITY: ZIP:
FULL SOCIAL SECURITY #: DATE OF BIRTH:
PHONE: EMAIL:
ADDRESS TO MAIL BALLOT TO (IF DIFFERENT):
CITY: STATE: ZIP:
INDICATE THE BALLOT YOU ARE REQUESTING (REQUIRED)
Republican Primary and
Democratic Primary and
General Election Only
ONLY ONE PRIMARY MAY BE SELECTED
CHECK THE REASON FOR REQUESTING TO VOTE BY MAIL (REQUIRED)
I am 60 years of age or older.
I will be outside my county during all hours of early voting and before the polls close on Election Day.
I am hospitalized, ill or physically disabled and unable to appear at my polling place to vote; and/or I have determined it is
impossible or unreasonable to vote in-person due to the COVID-19 situation.
I am a caretaker of a hospitalized, ill or physically disabled person, and/or I have determined it is impossible or
unreasonable to vote in-person due to the COVID-19 situation.
I am a full-time student or spouse of a full-time student outside my county.
I reside in a licensed facility, outside my county, providing relatively permanent domiciliary care, i.e. Nursing Home.
I am a candidate for office in the election for which I am applying to vote absentee by mail.
I am observing a religious holiday that prevents me from voting during early voting or on Election Day.
I will be serving as an election official or a member or employee of the election commission on Election Day.
I will be serving on jury duty in state or federal court.
I am a voter with a disability and my polling place is inaccessible.
I have a CDL or TWIC or I am a spouse of a person with a CDL or TWIC and will be out of the county during early voting
and Election Day and have no out of the county address to receive mail during this time. Enclosed is a copy of the CDL or
TWIC (required) and the number is: ________________________________.
I am a member of the military, spouse, or dependent.
I am an activated National Guard member on state orders.
I am an overseas citizen and otherwise qualified to vote in TN.
You must include a mailing address outside the
county, even if the ballot is emailed.
Send military/overseas ballot by:
Mail or Email
If email, provide email address above.
I swear or affirm, under the penalty of perjury, that all of the information on this form is true and correct and that I am
eligible to vote in the election.
REQUIRED
VOTER’S SIGNATURE:
(Digital Signature Not Accepted)
DATE:
(only required if voter cannot sign their own name)
____________________________________ ________________________________________ _____________
SIGNATURE OF PERSON ASSISTING ADDRESS DATE
____________________________________ ________________________________________ _____________
SIGNATURE OF WITNESS ADDRESS DATE
APPROVED / REJECTED DATE _____________ BY_____________BALLOT SENT DATE _____________ BALLOT RECEIVED DATE _____________
To vote by mail you must meet one of the reasons listed below and
submit a request no later than the 7
th
day before the election.
Note: If you have never voted before and you registered to vote by mail,
then you must vote IN-PERSON the first time you vote.
ABSENTEE BY-MAIL
BALLOT REQUEST
