Fillable Form 1.: Minnesota Applicaon to Automacally Receive Absentee (Minnesota Department of Revenue)

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Form 1.: Minnesota Applicaon to Automacally Receive Absentee (Minnesota Department of Revenue)

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Minnesota Applicaon to Automacally Receive Absentee
Ballot Applicaons
Complete lines 1 through 6. Please print clearly.
1.
1.
last name or surname rst name middle name sux
2.
apt
date of birth (mm/dd/yyyy)
sign here: X__________________________ date ____/____/____
county where you live
phone number
email address
3.
mark all boxes that apply:
I have a MN-issued driver’s license or MN ID card. The number is:
I have
a social security number. The last four digits are: XXX-XX-
I do not have a MN-issued Driver’s License, MN-issued ID card or a social security number.
4.
add
ress where you live (residence)
city
MN
zip code
5.
address where your absentee ballot applicaon should be sent
city state zip code
6.
See other side for special instrucons for voters with disabilies or power of aorney.
- -
Return this applicaon as soon as possible to:
Where to return your applicaon
You should return this to your local elecon oce. If not
provided above, contact information for your local election
official can be found under “Find County Election Office"
at http://www.mnvotes.org.
Opons for returning this applicaon
This applicaon may be returned by mail, fax or as a
scanned aachment to an email.
Privacy Notice:
Your exact date of birth, email address, and any ID
number you give (Minnesota driver's license, state ID or
last four digits of social security number) are private. Only
election officials may access it.
Election officials ask for your exact date of birth so they
can match your application to your voter record. If you
refuse to give your date of birth, you won’t get an
absentee ballot.
Election officials ask for your email so they can contact
you about your application. Also, the Office of the
Secretary of State may email you (or contact you another
way) about voting and elections, or ask for public input. If
you refuse to give an email address, you cannot apply for
an absentee ballot online and you will need to apply with
a paper application.
Election officials ask for an ID number to check that the
person who is casting the ballot is the same person who
applied for it. If you have an ID number but refuse to give
it, your absentee ballot might get rejected, and you won’t
be able to check your absentee ballot status online.
The rest of the data on your application is public when
used for elections, political or law enforcement purposes.
If you need to keep your contact data private because of
personal safety concerns, call 1-877-600-8683 to learn
what you can do.
Informaon for acve-duty military and overseas
voters:
If you are applying for an absentee ballot because you or
your family are acve-duty military or because you will be
overseas and/or outside of the territorial limits of the Unit-
ed States, do not use this applicaon. You are entled to
special protecons if you apply using the Federal Postcard
Applicaon. For more informaon and to apply online, go
to hp://www.mnvotes.org
Opons available to you if you have a disability
You may:
sign the applicaon yourself,
make your mark, or
ask another person to sign for you in your presence
(have the person sign their own name as well.)
If you have adopted the use of a signature stamp for all
purposes of signature, you may use your signature
stamp or ask another person to use your signature
stamp in your presence. (See Minnesota Statutes,
secon 645.44, subdivision 14. )
Informaon regarding Power of Aorney
Voting is not covered by power of attorney. A power of
attorney pertains only to affairs affecting property. A per-
son with power of attorney may only sign for you in your
presence, as outlined above. (See Minnesota Statutes,
secon 523.24, subdivision 14.)
Revised 12-21-2017
Stearns County Auditor's Office
Administration Center Room 148
705 Courthouse Square
St Cloud MN 56303
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Form 1.: Minnesota Applicaon to Automacally Receive Absentee (Minnesota Department of Revenue)

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Completed 6 August 2020

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