Fill - Free fillable Absenteeballot - Absentee Ballot Request Form 7-1-14 half sheet PDF form

*Indicatesrequiredinformation STATEOFIOWAOFFICIALABSENTEEBALLOTREQUESTFORM

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 Last

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 First

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 Middle Suffix 

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 DateofBirth(month,day,year)//

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IowaDriver’sLicenseorNon‐OperatorIDNumber: 

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LastFourDigitsofSocialSecurityNumber: XXX–XX–

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Youmustberegisteredtovoteinthecountytoreceiveanabsenteeballot.Ifyouareregisteredtovoteinthecounty,thisformwillbeusedto

updateyourvoterregistrationiftheinformationprovidedonthisformisdifferentthantheinformationonyourregistrationrecord.

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 HomeStreetAddress(includeapt,lot,etc.ifapplicable)

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 CityZip County

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 Address/P.O.Box

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 CityState Zip

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 Country(otherthanUSA)

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 Phone

  Email

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 General Primary SchoolCitySpecial:

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OR ElectionDate: //   

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PrimaryElectionsOnly:checkonepoliticalparty Democratic  Republican

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IswearoraffirmthatIamthepersonnamedaboveandIamaregisteredvoterorIamentitledtoregisterattheaddresslistedonthisform.

Iameligibletoreceiveandvoteanabsenteeballotfortheelectionindicatedabove.

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Signature  Date 

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YOURNAME*AND

DATEOFBIRTH*

NUMBER

(Checkandcompleteone)

YOURIOWA

ESIDENTIALADDRESS*

WHEREYOUR

ABSENTEEBALLOT

SHOULDBEMAILED

(Ifdifferentthanabove)

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FFIC

E

CONTACTINFO

LECTIONTYPEORDATE*

(Provideelectiontypeordate.Choose

onlyoneelection.)

PARTYAFFILIATION

REQUESTERAFFIDAVIT*

(Powersofattorneydonothavelegal

authoritytorequestanabsentee

ballotonbehalfofanother.)

Revised 7/1/2014

✔

Indian Hills Bond Referendum

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Absenteeballot - Absentee Ballot Request Form 7-1-14 half sheet

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