1. PRINT Name: 2. Phone:
3. Davidson Co. address where you live:
Check if NEW Address
4. Mail my absentee ballot to this address (if different from above):
5. Date of Birth: 6. ENTIRE Social Security number: __ __ __ - __ __ - __ __ __ __
7. Email (optional, but helpful for communication):
8. THIS ELECTION IS A PRIMARY. SELECT ONE:
REPUBLICAN DEMOCRATIC County General ONLY
& County General & County General
9. My legal reason for voting Absentee is (CHECK ONE):
____ I am sixty (60) years of age or older.
____ I am hospitalized, ill, or physically disabled, and unable to appear at my polling place to vote; and/or I have
determined it is impossible or unreasonable to vote in person due to the COVID-19 situation.
____ I am a caretaker of a hospitalized, ill or physically disabled person, and/or I have determined it is impossible or
unreasonable to vote in person due to the COVID-19 situation.
____ I will be outside of Davidson County during all hours of Early Voting (July 17-Aug 1) and Election Day.
____ I am enrolled as a full-time student or I am the spouse of a student at an institution outside Davidson County.
____ I am a voter with a disability and my polling place is inaccessible.
____ I reside in a licensed facility, outside the county, providing relatively permanent care, i.e. nursing home.
____ I am a candidate.
____ I am on jury duty in a state or federal court.
____ I am serving as an election official or a member or employee of the Election Commission on Election Day.
____ I am observing a religious holiday that prevents me from voting early or on Election Day.
____ I am a member of the military, spouse, or dependent ; an activated National Guard member on state orders ;
an overseas citizen and otherwise qualified to vote in TN (See #4 above: you must include a mailing address
outside Davidson County, even if ballot is emailed) Send military/overseas ballot by: Mail Email (Provide email on Line 7)
I swear or affirm, under penalty of perjury, that all information on this form is true and correct and that I am eligible to vote in this election.
Signature of Voter:
Digital Signature NOT Accepted…..Original Signature REQUIRED
If voter cannot sign or if assistance is given, the following is REQUIRED:
Signature and address of person assisting:
Signature and address of person witnessing:
Mail, Fax, OR Email to:
Davidson County Election Commission
ATTN: Absentee Department
P.O. Box 650
Nashville, TN 37202-0650
Fax: 615-880-1729
Email: moaballot@nashville.gov
A new Absentee Ballot Request must be submitted for the November 3, 2020 election, if needed.
(615) 862-8815 * www.nashville.gov/vote * TTY (800) 848-0298 or Relay 711
I request an ABSENTEE BALLOT from the DAVIDSON COUNTY ELECTION COMMISSION for:
State and Federal Primary
& County General Election
August 6, 2020
Completed form must be
received in Election
Commission office between:
May 8, 2020 and
July 30, 2020
revision 6/29/2020
