Voted absentee ballots must be received by the Municipal Clerk by 8 p.m. on July 14, 2020.
1. Full Name of Registered Voter Requesting the Ballot
2. Residence Address of Voter
(Street Address) (Municipality)
3. Voter’s Date of Birth ___ ___ / ___ ___ / ___ ___ ___ ___
m m d d y y y y
4. Daytime Phone Number (optional)
5. Method of Delivery of Ballot to the Voter
a. Issued to Voter (Application Required if Voter will Vote Outside the Municipal Clerk’s Presence)
b. By Mail to this Address
c. By Immediate Family Member of Voter
Designated Here
(Name) (Relationship to Voter)
d. By this 3
Person (Designated by the Voter)
(Name) (Telephone #)
6. Signature of Voter OR
Immediate Family Member of Voter Date
Note: If an immediate family member of the voter is completing this application, the relationship to the voter must be
provided in 5(c) above. The absentee ballot can be delivered to the immediate family member in person or mailed to
the address provided in 5(b).
7. Signature of Immediate Family Member Returning the Ballot
Relationship to Voter
(Complete Section #7 Only if Ballot was Delivered to the Voter or a Different Immediate Family Member of the Voter)
AIDE CERTIFICATE (Must be Completed if Applicant was Assisted as Designated Below)
If the voter received assistance in reading and/or signing this application, the person who assisted the voter must
complete and sign this certificate.
I helped this voter: read the application sign the application read and sign the application
Signature of Aide Printed Name of Aide
Application for Absentee Ballot
July 14, 2020
Primary/Special Referendum Election
Application Received
Ballot Sent/Delivered