Fillable FORM AV-R1: APPLICATION FOR ABSENTEE BALLOT (State of Alabama)

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FORM AV-R1: APPLICATION FOR ABSENTEE BALLOT (State of Alabama)

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Primary Election or Presidential Preference Primary
Select one:
APPLICATION FOR ABSENTEE BALLOT
______________________ COUNTY, ALABAMA
I hereby make application for an absentee ballot so that I may vote in the following election:
I am applying for an absentee ballot because (check at least one box):
I expect to be out of the county or the state on election day.
I have a physical illness or inrmity which prevents my attendance at the polls. [ID Required]
*I have a physical illness or inrmity which prevents my attendance at the polls. I am unable to access my assigned polling place due to a
neurological, musculoskeletal, respiratory (including speech organs), cardiovascular, or other life-altering disorder that affects my ability to
perform manual tasks, stand for any length of time, walk unassisted, see, hear or speak and:
a) I am an elderly voter aged 65 or older; or
b) I am a voter with a disability.
*[ID Not Required]
I expect to work a shift which has at least ten (10) hours that coincide with the polling hours at my regular polling place.
I am enrolled as a student at an educational institution located outside the county of my personal residence,
attendance at which prevents my attendance at the polls.
I am a member of, or a spouse or dependent of a member of, the Armed Forces of the United States or am otherwise similarly qualied to vote
absentee pursuant to the Uniformed and Overseas Citizens Absentee Voting Act, 52 U.S.C. § 20302. [ID Not Required]
This application for an absentee ballot will be valid for all county, state, and federal elections held during this calendar year unless you
specify an earlier expiration date here: _______________________________.
I have been appointed as an election ofcer at a polling place which is not my regular polling place.
I am a caregiver for a family member to the second degree of kinship by afnty or consanguinity and the family member is conned to his or her
home.
I am currently incarcerated in prison or jail and have not been convicted of a felony involving moral turpitude. (See back for felonies involving
moral turpitude.)
Democratic Party
Mail my ballot to the address where I regularly receive mail, if different from the street address provided above
Precinct where you vote (name and/or location of your polling place)
Work Telephone Number
Date of Birth
Home Telephone Number
General Voter Information - Please provide complete information so that we may verify your eligibility to vote.
Republican Party
Other ____________
Amendments Only
General Election Special Election (specify) __________________________
For all registered voters
n Absentee ballots for elections more than 42 days apart must be requested on separate applications, unless you are a member of the
armed forces, or a spouse or dependent of such person, or you are a United States citizen residing overseas, or are permanently
disabled.
n An application submitted by a member of the armed forces, or a spouse or dependent of such person, or a United States citizen
residing overseas is valid for all county, state and federal elections in the current calendar year. An application submitted by a citizen
with a permanent disability is valid for all municipal, county, state, and federal elections in the current calendar year.
Street Address (address where you are registered to vote; do not use PO box) City ZIP
YearDayMonth
( )
( )
Last Name (Please print)
First Name
Middle or Maiden Name
Driver’s License Number
STATE
NUMBER
IF NO DRIVER’S LICENSE NUMBER
Last 4 digits of
Social Security
number
E-mail Address
FORM AV-R1
Date Revised 09/03/2019
State
Primary Runoff Election
Select one:
Democratic Party
Republican Party
Other ____________
Amendments Only
Democratic Party
Republican Party
If a primary or runoff, check one:
Please note that a copy of your valid photo identication must be submitted along with this application.
When I apply for this absentee ballot, I understand that my name will be stricken from the list of qualied electors and, when I cast this
absentee ballot, I understand that I will not be entitled to vote at my regular polling place.
The voter may hand this application to the Absentee Election Manager. The voter may also forward this application to the Absentee Election Manager by U.S.
Mail or commercial carrier [§17-11-3 and §17-11-4, Code of Alabama, 1975].
READ PENALTIES ON BACK
Voter’s Signature
Witness Signature
Print Witness Name
Complete this
section if voter
signs by mark
Revised 2019.06.18
Please note that only one application may be placed in the same envelope.
Return this application to:
Autauga County AEM
PO Box 681864
Prattville, Alabama, 36068
CRIMES INVOLVING MORAL TURPITUDE
Pursuant to Code of Alabama (1975) Section 17-3-30.1
• Murder – Section 13A-5-40 (A) 1-19
• Murder (Non-Capital, Reckless, Felony Murder, etc.) – Section
13A-6-2
• Manslaughter – Section 13A-6-3 Exceptions: 13A-6-20 (A) (5)
and 13A-6-21
• Assault 1st Degree – Section 13A-6-20
• Assault 2nd Degree – Section 13A-6-21
• Kidnapping 1st Degree – Section 13A-6-43
• Kidnapping 2nd Degree – Section 13A-6-44
• Rape 1st Degree – Section 13A-6-61
• Rape 2nd Degree – Section 13A-6-62
• Sodomy 1st Degree – Section 13A-6-63
• Sodomy 2nd Degree – Section 13A-6-64
• Sexual Torture – Section 13A-6-65.1
• Sexual Abuse 1st Degree – Section 13A-6-66
• Sexual Abuse 2nd Degree – Section 13A-6-67
• Sexual Abuse of a child less than 12 years old – Section 13A-6-
69.1
• Enticing a child to enter a vehicle, house, etc. for immoral pur-
poses – Section 13A-6-69
• Facilitating solicitation of unlawful sexual conduct with a child –
Section 13A-6-121
• Electronic solicitation of a child – Section 13A-6-122
• Facilitating the on-line solicitation of a child – Section 13A-6-123
• Traveling to meet a child for an unlawful sex act – Section 13A-
6-124
• Facilitating the travel of a child for an unlawful sex act – Section
13A-6-125
• Human Trafcking 1st Degree – Section 13A-6-152
• Human Trafcking 2nd Degree – Section 13A-6-153
• Terrorism – Section 13A-10-152
• Soliciting or providing support for an act of terrorism – Section
13A-10-153
• Hindering prosecution of terrorism – Section 13A-10-154
• Endangering the water supply – Section 13A-10-171
• Possession, manufacture, transport, or distribution of a destructive
device or bacteriological weapon, or
biological weapon – Section 13A-10-193
• Selling, furnishing, giving away, delivering, or distribution of a
destructive device, a bacteriological
weapon, or biological weapon to a person who is less than 21 years
of age – Section 13A-10-194
• Possession, manufacture, transport, or distribution of a detonator,
explosive, poison, or hoax device –
Section 13A-10-195
• Possession or distribution of a hoax device represented as a
destructive device or weapon –
Section 13A-10-196 (c)
• Attempt to commit an explosives or destructive device or bacterio-
logical or biological weapons crime –
Section 13A-10-197
• Conspiracy to commit an explosives or destructive device or bacterio-
logical or biological weapons crime –
Section 13A-10-198
• Hindrance or obstruction during detection, disarming, or destruction
of a destructive device or weapon –
Section 13A-10-199
• Possession or distribution of a destructive device or weapon intended
to cause injury or destruction –
Section 13A-10-200
• Treason – Section 13A-11-2
• Dissemination or public display of obscene matter containing visual
depiction or persons under 17 years of
age involved in obscene acts – Section 13A-12-191
• Possession and possession with intent to disseminate obscene matter
containing visual depiction of persons
under 17 years of age involved in obscene acts – Section 13A-12-192
• Parents or guardians permitting children to engage in production of
obscene matter – Section 13A-12-196
• Production of obscene matter containing visual depiction of persons
under 17 years of age involved in
obscene acts – Section 13A-12-197
• Distribution, possession with intent to distribute, production of ob-
scene material, or offer or agreement to
distribute or produce – Section 13A-12-200.2
• Trafcking in cannabis, cocaine, or other illegal drugs or trafcking in
amphetamine and
methamphetamine – Section 13A-12-231
• Bigamy – Section 13A-13-1
• Incest – Section 13A-13-3
• Torture or other willful maltreatment of a child under the age of 18 –
Section 26-15-3
• Aggravated child abuse – Section 26-15-3.1
• Prohibited acts in the offer, sale, or purchase of securities – Section
8-6-17
• Burglary 1st Degree – Section 13A-7-5
• Burglary 2nd Degree – 13A-7-6
• Theft of Property 1st Degree – Section 13A-8-3
• Theft of Property 2nd Degree – Section 13A-8-4
• Theft of Lost Property 1st Degree – Section 13A-8-7
• Theft of Lost Property 2nd Degree – Section 13A-8-8
• Theft of trademarks or trade secrets – Section 13A-8-10.4
• Robbery 1st Degree – Section 13A-8-41
• Robbery 2nd Degree – Section 13A-8-42
• Robbery 3rd Degree – Section 13A-8-43
• Forgery 1st Degree – Section 13A-9-2
• Forgery 2nd Degree – Section 13A-9-3
• Aggravated Theft by Deception – Section 13A-8-2.1
• Any crime as dened by the laws of the United States or by the laws
of another state, territory, country, or
other jurisdiction, which, if committed in this state, would constitute
one of the offenses listed in this subsection.
PENALTIES
§17-17-24, Code of Alabama, 1975, as amended
(a) Any person who willfully changes an absentee voter’s ballot to the extent that it does not reect the voter’s true ballot, any person who willfully
votes more than once by absentee ballot in the same election, any person who willfully votes for another voter or falsies absentee ballot applications or verication
documents so as to vote absentee, or any person who solicits, encourages, urges, or otherwise promotes illegal absentee voting, shall be guilty, upon conviction, of a
Class C felony. Any person who willfully aids any person unlawfully to vote an absentee ballot, any person who knowingly and unlawfully votes an absentee ballot, and
any voter who votes both an absentee and a regular ballot at any election shall be similarly punished.
(b) Upon request by the local district attorney or the Secretary of State, the Attorney General shall provide investigating assistance in instances of absentee
ballot or voting violations.
(c) Nothing in this section shall be construed to impede or inhibit organized legal efforts to encourage voter participation in the election process or to
discourage a candidate from encouraging electors to lawfully vote by absentee ballot.
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FORM AV-R1: APPLICATION FOR ABSENTEE BALLOT (State of Alabama)

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Completed 28 September 2020

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