Ballot By Mail
IMPORTANT NOTE: An annual application for a ballot by mail should be submitted in the calendar year for which
the applicant wishes to receive ballots. During a primary election year, you must indicate the party’s primary for
which you wish to receive a ballot. A Ballot by Mail Application is required to receive a ballot for an election. When
calling to request an application by phone, remember to allow enough time for the application to be mailed to you
and returned in order to be in the office by the deadline. (must be received by the posted date, not postmarked)
To
be eligible to vote early by mail in Texas, you must:
1. be 65 years or older; or
2. be disabled; or
3. be confined in jail, but otherwise eligible; or
4. be out of the county on election day and during the period for early voting by personal appearance.
In
order to claim number 4 as the reason for voting by mail, a voter must expect to be absent from the county on
election day and during the period of early voting by personal appearance or for the remainder of the period after
their application is submitted. The ballot must be mailed to an address outside the county. IMPORTANT: Give date
you can begin to receive mail at the address given.
Vo
ters are reminded that both during early voting and on Election Day, if they are physically unable to enter the
poll, they may vote curbside. If the voter wishes to vote curbside during early voting, it would be helpful for them
to call the Election Office at 659-6541 to advise the office that they wish to vote in this manner.
An application must be submitted to the early voting clerk by:
1. Mail [113 W. Beauregard Ave., San Angelo, Texas, 76903]
2. Common or contract carrier
3. Telephonic facsimile machine, if a machine is available in the clerk’s office (325-657-9226) or
4. Electronic transmission of a scanned application containing an original signature (email:elections@co.tom-
green.tx.us).
NEW: For ballot by mail applications submitted by fax or email the original application must be
mailed to the early voting clerk and received no later than the 4
th
business day after the faxed or
emailed application was received.
Solicitud por Boleta por Correo (revisado 01/03/2018)
NOTA IMPORTANTE: Solicitudes para boletas por correo anual deberán presentarse en el año que el solicitante
desea recibir las boletas. Durante un año de elección primaria, uno debe indicar el partido primario para el cual
quiere recibir una boleta. Una solicitud de boleta por correo es requerida para recibir una boleta para la elección.
Cuando llame para solicitar una aplicación, acuérdese de permitir bastante tiempo para que la aplicación sea
enviada y devuelta a esta oficina antes de la fecha limite (las solicitudes deben ser recibidas antes de la fecha
publicada, no matasellada).
Pa
ra ser elegible para votar anticipadamente por correo en Texas, usted debe:
1. 65 o mas años de edad; o
2. Minusvalidez; o
3. Encarcelamiento, pero por lo demás ser elegible; o
4. Expectativa de estar fuera del condado durante el Día de Elecciones y durante la votación adelantada en
persona.
Pa
ra ser elegible para votar temprano por correo usando la opción numero 4, el votante debe esperar estar fuera
del condado durante el Día de Elecciones y durante la votación adelantada en persona o por el resto del período,
después de que su aplicación sea sometida. La boleta debe ser enviada a una dirección fuera del condado.
IMPORTANTE: Indique la fecha en que puede comenzar a recibir correo en la dirección indicada.
Vo
tantes son recordados que si son físicamente incapacitado a entrar al lugar de votación durante votación
adelantada y en el Día de Elecciones, usted puede votar en la acera. Si el votante desea votar en la acera durante
votación adelantada, es útil llamar la Oficina de Elecciones a (325)659-6541 para avisarnos que usted quiere votar
en esta manera.
Una
solicitud puede ser enviada a la secretaria de votación adelantada por medio de:
1. Correo [113 W. Beauregard Ave., San Angelo, Texas, 76903]
2. Portador común o portador de contrato
3. Fax telefónica, si esta disponible en la oficina de la secretaria [325-657-9226] o
4. Transmisión electrónica de una solicitud escaneada con firma original (correo electrónico:
elections@co.tom-
green.tx.us).
NUEVO: Para las solicitudes de voto por correo enviadas por fax o correo electrónico, la solicitud
original debe enviarse por correo al secretario de votación anticipada y debe recibirse a s tardar
el cuarto día hábil posterior a la recepción de la solicitud enviada por fax o por correo electrónico.
DO NOT REMOVE PERFORATED TABS. Moisten here and fold bottom to top to seal. DO NOT REMOVE PERFORATED TABS. Moisten here and fold bottom to top to seal.
Application for Ballot by Mail
Prescribed by the Ofce of the Secretary of State of Texas
A5-15 12/17
For Ofcial Use Only
VUID #, County Election Precinct #,
Statement of Residence, etc.
1
Last Name (Please print information) Sufx (Jr., Sr., III, etc) First Name Middle Initial
2
Residence Address: See back of this application for instructions.
City
,TX
ZIP Code
3
Mail my ballot to: If mailing address differs from residence address, please complete Box # 7.
City State ZIP Code
4
Date of Birth (mm/dd/yyyy) (Optional)
Contact Information (Optional)*
Please list phone number and/or email address:
* Used in case our ofce has questions.
5
Reason for Voting by Mail:
65 years of age or older. (Complete Box #6a)
Disability. (Complete Box #6a)
Expected absence from the county. (Complete Box #6b and Box #8)
You will receive a ballot for the upcoming election only
Connement in jail. (Complete Box #6b)
You will receive a ballot for the upcoming election only
6a
ONLY Voters 65 Years of Age or Older or Voters with a Disability:
If applying for one election, select appropriate box.
If applying once for elections in the calendar year, select “Annual Application.”
Annual Application
Uniform and Other Elections:
May Election
November Election
Other
___
Primary Elections:
You must declare one political party to vote in
a primary:
Democratic Primary
Republican Primary
Any Resulting Runoff
6b
ONLY Voters Absent from County or Voters Conned in Jail:
You may only apply for a ballot by mail for one election, and any resulting runoff.
Please select the appropriate box.
Uniform and Other Elections:
May Election
November Election
Other _
___
Primary Elections:
You must declare one political party to vote in
a primary:
Democratic Primary
Republican Primary
Any Resulting Runoff
7
If you are requesting this ballot be mailed to a different address (other than residence), indicate where the ballot
will be mailed. See reverse for instructions.
Mailing Address as listed on my voter registration certicate
Nursing home, assisted living facility, or long term care facility
Hospital
Retirement Center
Address of the jail
Relative; relationship __
Address outside the county (see Box #8)
___
8
If you selected “expected absence from the county,” see reverse for instructions
Date you can begin to receive mail at this address Date of return to residence address
9
Voters may submit a completed, signed, and scanned application to the Early Voting Clerk at:
(early voting clerk’s e-mail address ) (early voting clerk’s fax)
NOTE: If you fax or e-mail this form, please be aware that you must also mail the form to the early voting clerk within four
business days. See “Submitting Application” on the back of this form for additional information.
10
“I certify that the information given in this application is true, and I understand that giving false information
in this application is a crime.”
X
Date
SIGN HERE
If applicant is unable to sign or make a
mark in the presence of a witness, the
witness shall complete Box #11.
If someone helped you to complete this form or mails the form for you, then that person must complete the sections below.
11
See back for Witness and Assistant denitions.
If applicant is unable to mark Box #10 and you are acting as a Witness to that fact, please check this box and sign below.
If you assisted the applicant in completing this application in the applicant’s presence or e-mailed/mailed or faxed the application on behalf of the applicant, please check this box as an Assistant and sign below.
*
If you are acting as Witness and Assistant, please check both boxes.
Failure to complete this information is a Class A misdemeanor if signature was witnessed or applicant was assisted in completing the application.
X
Signature of Witness /Assistant
Street Address Apt Number (if applicable)
State
X
Printed Name of Witness/Assistant
City
ZIP Code
(Refer to Instructions on back for clarification)
Witness’ Relationship to Applicant
Este formulario está disponible en Español. Para conseguir la version en Español favor de llamar sin cargo al 1.800.252.8683 a la ocina del Secretario de Estado o la Secretaria de Votación por Adelantado.
_________________________________________ ___________________________________
0
0
Instructions
for
Application
for
Ballot
by Mail
Residence Address -
Give
full
address
as
shown
on
your
lIoter registration certificate. If
you
have
mOiled
within the county
but
not yet
changed
your
lIoter registration address
with
the
lIoter
registrar,
indicate your
new
residence
address.
Mail Ballot
To
- Gille full address where
you
wish
to
halle ballot
mailed,
if
the
address
is
different
from
your residence address.
Mailing BaNot
to a OiffwentAddress -
Your
ballot
must
be
mailed
to
your
home where
you
lille
or
to
your mailing address
on
your lIoter registration certificate.
There
are
some
exceptions
that
allow
you
to
halle your ballot
mailed
to
a different location
as
speCified
below.
Nursing home, assisted
~~""bJ_/
I
living/retirement center, relative,
,
~
hospital
~
In
jail
Address of jail or relative
! Absent from county
Address located outside
of
~
Expected Absence from County
-If
you
chose
expected
absence
from
county,
you
must
expect
) to
be
absent
from
the
county
on
election
day
and
during
the
hours of early lIoting
in
person
or
~
for the remainder of
the
early
1I0ting
period
after
you
submit your application. Your ballot must
II be mailed
to an address outside
the
county. Important: Give date
you
can
begin
to receille
..
mail
at
the
address
gillen.
Annual Application
·If
you
are
65
years
of
age
or
older,
or disabled
you
may
apply
to receille
all
'I
ballots by
mail
for a calendar
year.
If
you
do
not select any elections
in
Box
68,
your
application
will
be
considered
an
Annual Application. If
you
submit
an
annual
application for a ballot
by
mail,
~
your application
may
be
forwarded
to
other entities holding elections
where
you
are a qualified
lIoter.
This means that
you
may
receille a ballot for those elections
in
addition
to
the
ballot(s)
..
you
requested
with
this application.
-
"
Subrr'p"!lng
AOD
catIon
~
1. Sign aftd date
your
application
-If
unable to
sign,
please
go
to Witness/Address
boxes
(11
,J
on
reverse)
and
have a person witness your
marie
Witness/Assistant instructions
fOllow
below.
..
~
2.
DeliYer to Early Voting Clerk -
You
may
submit
your
application Ilia
these
methods:
"t
~;
Only
the applicant
may
submit their application
in
person
to
the
Early
Voting
Clerk
)
until
the
early
1I0ting
period
begins.
However,
after
the
early
1I0ting
period begins for
an
election,
~
the applicant
may
only
submit
their application Ilia
mail,
common
contract
carrier,
fax,
or
e·mail.
..
..
~:
You
may
mail
your
application Ilia the
U.S.
Postal
Service
.
By
Common
Contract
Carder:
You
may
submit Ilia a
common
or
contract carrier which is a
bona
fide,
for profit
carder.
~
~;
You
may
fax
your application
to
the
Early
Voting
Clerk.
Please contact your
Early
Voting
>
~
Clerk or
It1e
Secretary of State's Office
for
fax
numbers .
..
1
~;
You
may
e-mail a
signed,
scanned
image
of your application
to
the
Early
Voting
Clerk.
1
Please
contact
your Early
Voting
Clerk or
the
Secretary of State's Office
for
e-mail
addresses.
]
)
IF
YOU
FAX
OR
E-MAIL
YOUR
APPLICATION
TO
THE
EARLY
VOTING CLERK,
YOU
MUST
"
ALSO MAIL
THE
APPLICATION
SO
THAT
THE
CLERK RECEIVES
IT
NO
LATER
THAN
..
THE
FOURTH
BUSINESS
DAY
AFTER
THE
DAY
THE
CLERK RECEiVED
YOUR
FAXED
OR
EMAILED APPLICATION.
If
you fax
or
e-mail
your
application by
the
deadline noted below,
J
,
your
application wltl be considered complete and timely
as
long
as
the Original is recelYed
;
by
the
early Yotlng clerk
by
the
fourth business day after
!twas
submitted by fax
or
e-mail.
)
..
..
Your
application must
be
received
by
the
early
voting clerk of
the
local
entity conducting
the
election not later
than
the
11th
day
before election
day.
If
the
11th
day
is
a
weekend
or
holiday,
,
the
deadline is the first preceding business
day.
You
may
submit
an
application throughout
the
;
calendar
year,
beginning
January
1,
Please
remember
that
the
application must
be
receilled not
later
than
the
11th
day
before
the
first election
in
which
you
seek
to
lIote
by
mail,
~
~
If
you
submit
an
Annual
Application for Ballot
by
Mail
within
60
days before
an
election that
takes
t
,
place
in
the
following calendar
year,
your application will
be
lIalid for
any
election that takes place
..
in
the
following calendar
year,
regardless of
the
fact that
your
application
was
submitted prior
;
to
the
end
of
the
preceding calendar
year.
This
applies
to
Annual
Applications
only
and
not
to
a
J regular application for ballot by
mail.
I
,
i
Wltness,Asslstant
Section
WItness: If
you
are unable
to
sign
your
name
(due
to
a physical disability
or
illiteracy),
the
I
1
application
may
be
signed at
Box
#11
for
you
by
a
Witness.
You
must
affix
your
mark
to the
applicatlbn.in Box
#10
or,
if
you
are
unable
to
make
a
mark,
then
the
Witness
must check
the
~
approprr!!1E!
box
in
11
indicating the inability
to
make
a
mark.
The
Witness must state his/her
name
inplinted
form
and
indicate his/her relationship to
you
or,
if unrelated, state that
fact.
The
Witness must
sign
and
prOllide
his
or her pdnted
name
and
residence address,
Unless
the
Witness
is
a
close
relative of
the
lIoter
(parent,
grandparent,
spouse,
child
or sibling), it
is
a
Class
B misdemeanor for a
person
to
witness
more
than
one
application for ballot by
mail.
Assistant: If a
person
(other
than
a close relatille
or
person
registered to vote at the
same
address) assists
you
in
completing this application
in
your presence or mails/faxes/e·mails this
application
on
your behalf,
then
that
person
must complete
Box
#11.
The
Assistant must sign,
provide
his
or
her printed
name,
and
his
or her residence
address.
A
person
commits
a Class
A misdemeanor if
the
person
provides assistance without providing the information described
above
unless a close relatille or registered
at
your
address.
,
yo,
hlh'"
+
..
vtnE"
0
....
e'5t,on5
or
need
additional
assistance
please
contact
VO~·
Ea'
liO"'i9
C'e"
0'
Tne
Secretary
Of
State
s
office
at
1·800·252·8683
o~
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