1. PRINT Name: 2. Phone:
3. Davidson Co. address where you live:
Check if NEW Address
Mail my absentee ballot to this address (if different from above):4.
6. ENTIRE Social Security number: - __ - __ __
5. Date of Birth: _______________________
__ __ __ __ ____
7. Email (optional, but helpful for communication): ______
8. 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 (this includes
persons who have underlying medical or health conditions which in their determination render them more
susceptible to contracting COVID-19 or at greater risk should they contract it).
____
I am a caretaker of a hospitalized, ill or physically disabled person (this includes caretakers for persons who
have underlying medical or health conditions which in their determination render them more susceptible to
contracting COVID-19 or at greater risk should they contract it).
____
I will be outside of Davidson County during all hours of Early Voting (October 14-29) 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 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
Assistance Signatures (only required if voter cannot sign their own name):
Signature and address of person assisting: ___________________________________
_____________________________________________________________________
Signature and address of person witnessing: _________________________________
_____________________________________________________________________
If completed online, Print and SIGN, then Email, Mail, or Fax to:
EMAIL MAIL FAX
votebymail@nashville.gov Davidson County Election Commission (615) 880-1729
Nashville, TN 37202-0650
Track the date your ballot was ISSUED and RECEIVED at https://tnmap.tn.gov/voterlookup/
Rev 9.9.20 (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
General Election (Presidential)
and Belle Meade, Forest Hills or Goodlettsville Municipal Election, if applicable
November 3, 2020
Request deadline:
October 27, 2020
USPS recommends mailing
this form no later than
October 19, 2020 to ensure
timely return of voted ballot.
I am a member of the military, spouse, or dependent. ➔ You must include a mailing address outside ____
I am an activated National Guard member on state orders. ➔ Davidson County, even if ballot is emailed. ____
I am an overseas citizen and otherwise qualified to vote in TN. ➔ Send military/overseas ballot by: Mail Email ____
If email, provide email address on Line 7.
PO Box 650
NOTICE: You may be eligible for a reward of up to $1,000 if you make a report of voter fraud that leads to a conviction. Call the state election coordinator's Voter Fraud Hotline at 877-850-4959.
