Request an Absentee By-Mail Ballot for the November 3, 2020 Election
First Day to Accept a Request: August 5, 2020 Last Day to Accept a Request: October 27, 2020
To vote by-mail you must meet one of the reasons listed below and submit a request no later than the 7
day before the election.
Note: If you have never voted in this county before and you registered to vote by mail or online, then you must vote IN-PERSON
the first time you vote.
STEP 1: Provide all of the information below. Please print.
Your Full Legal Name:
Address Where You Live:
City: ZIP:
Date of Birth: Phone:
Full Social Security #: Email:
Mailing Address:
Same as above
City: State: ZIP:
STEP 2: Select your ballot.
November General Election
STEP 3: Check your reason for requesting to vote by-mail.
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.
I am a caretaker of a hospitalized, ill or physically disabled person.
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. 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.
STEP 4: Read the following statement and sign this form.
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.
Voter’s Signature:
(Digital Signature Not Accepted)
Assistance Signatures
(only required if voter cannot sign their own name):
____________________________________ ________________________________________ _____________
Signature of Person Assisting Address Date
____________________________________ ________________________________________ _____________
Signature of Witness Address Date
STEP 5: Submit your request.
You may submit this form by mail, fax or email to your county election commission. When emailing, you must scan and attach
the completed request form to the email. Click here or visit to find the address and contact information for your
election commission. Your request must be received by October 27, 2020.
NOTICE: You may be eligible for a reward of up to $1,000 if you make a report of voter fraud that leads to a conviction. Call the
state election coordinator’s Voter Fraud Hotline at 877-850-4959 to report voter fraud.
APPROVED / REJECTED DATE _____________ BY_____________BALLOT SENT DATE _____________ BALLOT RECEIVED DATE _____________
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