Instructions: Print and sign this document and then return it to the Boone County Clerk.
Email signed PDF to, or
FAX signed application to 573-886-4300, or
Mail signed application to "Boone County Clerk, 801 East Walnut, Rm 236, Columbia,
MO 65201."
Note: Ballots will be mailed 6 weeks prior to the election.
Absence from Boone County on Election Day;
Incapacity or confinement due to illness or physical disability, including a
person who is primarily
esponsible for the physical care of a person who is incapacitated or confined due to illness or disability;
Religious belief or practice;
Employment as an election authority, as a member of an election authority, or
by an election authority
at a location other than your polling place;
Incarceration, provided all qualifications for voting are retained
Certified participation in the address confidentiality program established under sections 589.660 to
589.661 because of safety concerns;
For an election that occurs during the year 2020, the voter has contracted or is in an at-risk category
for contracting or transmitting severe acute respiratory syndrome coronavirus 2.
I _____________________________________, declare that I am a resident and registered voter of Boone
County, Missouri, and request an absentee ballot for the following elections:
(Print Name)
August 2020 (Primary Election)
November 2020 (General Election)
If the election is a primary election, please check the political party ballot you wish to receive:
NonpartisanRepublican Democratic Libertarian Green Constitution
Reason for requesting an absentee ballot (check one):
Voter Registration Address:
(Street address)
(City, State, Zip Code)
Mail my ballot to the following address:
Telephone number:_______________________________
(Include area code)
I do solemnly swear that all statements made on this application are true to the best of my knowledge and belief.
Signature of Registered Voter Date
Mail this completed form to the Boone County Clerk's Office at 801 E. Walnut, Room 236, Columbia MO
65201 or email/fax this completed request to: (email) or (573) 886-4300 (fax).
Email: ____________________________________
(Street address)
(City, State, Zip Code)
(Optional) I am permanently disabled and hereby request that my name be placed on the election
authority’s list of voters qualified to participate
as absentee voters pursuant to Section 115.284, and
that I be delivered an absentee ballot application for each election in which I am eligible to vote.
Last four digits of social security number: ____________ Date of Birth: ________________
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