Fillable Absenteevoting - 2014 Absentee Ballot Request

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Absenteevoting - 2014 Absentee Ballot Request

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

GeneralInstructions

ApersonmustbearegisteredvoterintheirNorthCarolinacountyofresidenceinordertorequestanabsenteeballot.Ifnotregisteredto

voteinthepropercounty,apersonmustsubmitavoterregistrationapplicationalongwiththisform.Voterregistrationapplicationsare

availableonlineatwww.ncsbe.gov

.Thedeadlinetoregistertovoteis25dayspriortothedateoftheelection.

CompletingtheForm

Thevoter’sfullname,residentialaddress,dateofbirthandanidentificationnumber(seeProofofIdentificationbelow)mustbeprovided

onthisform.Thisinformationwillbeusedtoconfirmyourvoterregistration.Inaddition,thisformmustbesignedbythevoterorthe

voter’snearrelativeorqualified

legalguardian.

Whomaymakearequestforanabsenteeballot

Eitherthevoterorthevoter’snearrelativeorqualifiedlegalguardianmayrequestanabsenteeballot.A“nearrelative”isdefinedasthe

voter’sspouse,brother,sister,parent,grandparent,child,grandchild,mother‐in‐law,father‐in‐law,daughter‐in‐law,son‐in‐law,

stepparent,orstepchild.



Whomaynotmakearequestforanabsenteeballot

Ifaregisteredvoterisapatientinanyhospital,clinic,nursinghomeorresthomeinthisState,itisunlawfulforanyowner,manager,

director,employee,orotherperson,otherthanthevoter'snearrelativeorverifiablelegalguardian,torequestanabsenteeballoton

behalfofthevoter.

Thevoter’scountyboardofelectionsshouldbecontactedifavoterinahospital,clinic,nursinghomeorresthomein

thisStateneedsassistancerequestingorvotinganabsenteeballot.



UpdatingVoterInformation

Thisformmayalsoserveasavoterchangeform;however,changesinvoterregistrationmayonlybemadebythevoter.

ProofofIdentification

Ifthevoter’sidentificationnumber(NCdriverlicensenumber,NCDMV‐issuedidentificationcardnumber,orlastfourdigitsofsocial

securitynumber)isnotprovided,thenacopyofoneofthefollowingmustbeprovidedalongwiththisrequest:

1. Acurrentandvalidphotoidentification.

2. Adocumentthatshowsthenameandresidentialaddressofthevoter:acurrentutilitybill,bankstatement,governmentcheck,

paycheck,orothergovernmentdocument.



BallotAvailability

Absenteeballotingmaterialsaremailedtovotersonceballotsforanelectionareavailable.Formostelections,ballotswillbeavailable50

dayspriortothedateoftheelection.Absenteeballotsareavailable60dayspriortothedateofastatewidegeneralelectionand30days

priortothe

dateofacityormunicipalelection.

Submittingtheform

SubmitthisformtothePenderCountyBoardofElectionsnolaterthan5:00p.m.ontheTuesdaybeforethedateoftheelection.

Address:

807SWalkerSt.

P.O.Box1232

Burgaw,NC28425‐1232

Email:

pender.boe@ncsbe.gov

Fax:

910‐259‐1269



Thisformmaybemailed,faxed,emailed,ordeliveredinperson.Visitwww.ncsbe.gov

tocheckthestatusofyourabsenteerequest.

 StateAbsenteeBallotRequestForm

 NorthCarolina

 PenderCounty

PENDERCOUNTYBOARDOFELECTIONS

P.O.BOX1232

Burgaw,NC28425‐1232

PHONE:910‐259‐1220FAX:910‐259‐1269

Pender.boe@ncsbe.gov



FRAUDULENTLYORFALSELYCOMPLETINGTHISFORMISACLASSIFELONYUNDERCHAPTER163OFTHENCGENERALSTATUTES.



Iamrequestinganabsenteeballotforthe:  on

ElectionType(Primary,General,Municipal,Special,etc.) ElectionDate 

VoterInformation 

LastName FirstName MiddleName Suffix DateofBirth

 

HomeAddress(NCResidentialAddress.) MailingAddress(Ifdifferentthanhomeaddress.)



City State ZipCode City State ZipCode



Haveyoulivedatthisaddressformorethan30days? Yes No

CountyofResidence PreviousName(ifapplicable)

If“No,”indicatethedateofyourmove:

_____/_____/_____



Youmustprovideatleastoneidentificationnumberbelow.(orseeinstructions) VoterRegistrationNo. Phone(optional) Email(optional)

NCLicenseorIDNumber SSN

 

X X X‐X X‐





AbsenteeVotingInformation

AbsenteeMailingAddress(Whereshouldtheballotbemailed?) City State ZipCode



IfvoterisregisteredasUnaffiliatedandrequestingaballotforapartisanprimary,chooseaprimaryballotpreference. 

Democratic Republican Libertarian Non‐partisan

Ifvoterisapatientinahospital,clinic,nursinghomeorresthome,pleaseindicatewhetheryouwillneedassistanceinmarkingyourballot. Yes No



If“Yes,”whatisthenameandaddressofthehospitalorfacility:

Ifrequestinganabsenteeballotonbehalfofanearrelative,listyourname,address,contactinformationandrelationshiptothevoter:

Requestor’sName  spouse brother/sister parent grandparent stepparent

child grandchild stepchild mother‐in‐law father‐in‐law

son‐in‐law daughter‐in‐law legalguardian

  

(First) (Middle) (Last) (Suffix)

Requestor’sAddress NameofCorporation(Ifappointedlegalguardian)



City State ZipCode Requestor’sPhone Requestor’sEmail





ForMilitary/OverseasCitizensOnly(mayonlybesignedbythevoter;maynotbesignedbyanearrelative/guardian)

Selectoneoftheoptionsbelowtoqualifyasamilitaryoroverseasvoter:

MemberoftheUniformedServicesorMerchantMarineonactivedutyandcurrentlyabsentfromcountyofresidenceoraneligiblespouse/dependent.

U.S.citizenresidingoutsidetheU.S.temporarilyorindefinitely

CurrentAddress(Addresswhereyouarecurrentlystationedorlivingoverseas.)

Transmitmyballotby:

(Military/OverseasVotersOnly)



Mail Fax Email





FaxNumberorEmailAddress



SignatureofVoter(voteronly) SignatureofNearRelative/LegalGuardian(ifapplicable)



X



X





 Date    Date

Visitwww.NCSBE.govtocheckyourvoterregistrationorabsenteevotingstatus.

V2013.11

 StateAbsenteeBallotRequestForm

 NorthCarolina

 

TO: PENDERCOUNTYBOARDOFELECTIONS

P.O.BOX1232

BURGAW,NC28425‐1232



PHONE:910‐259‐1220 FAX:910‐259‐1269

Pender.boe@ncsbe.gov

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