5200 Civic Center Drive, Waterford, Michigan 48329
Telephone: (248) 674-6266 Fax: (248) 674-5455
E-mail: clerk@waterfordmi.gov / www.waterfordmi.gov
ABSENTEE VOTER - SPOILED BALLOT REQUEST
__________________________________________________________________________
(Please print your name and address)
Complete only if you want your ballot sent to a temporary address
__________________________________________________________________________
(St
reet
Address, City, State and Zip)
I further affirm that I am a resident of the Charter Township of Waterford, Michigan, and submitted an
application for an absent voter ballot for this election to the Charter Township of Waterford Clerk.
And that:
I spoiled my absent voter ballot and request a new ballot
I did not receive the absent voter ballot that I applied for and request a new ballot
I lost or destroyed the absent voter ballot I received and request a new ballot
I desire to vote in person and surrender my ballot
Signatu
re of
El
ector
:
X______________________________________Date:____________
By signing this affidavit, I swear that the statements made above are true. Form may be returned:
In person, USPS, fax or e-mail (clerk@waterfordmi.gov)
