Massachusetts Ofcial
Absentee Ballot Application
See reverse side for instructions
Legal Voting Residence:
Date of Birth: Telephone Number:
E-mail Address:
voters may vote in
a primary without
registering with a
Mail Ballot to:
Ballot Requested For:
All elections this year
All general elections (No primaries)
A specic election:
Date of Election
Party (only if requesting primary ballot):
State Primaries:
Presidential Primary:
(If applicable)
This application is being made by a family member of the voter.
Relationship to voter:
Voter is a member of military on active duty or dependent family member of
active duty personnel.
Voter is a Massachusetts citizen residing overseas.
Voter has been admitted to a healthcare facility after noon on the fth day
before the election and has designated the following person to hand-deliver
the ballot:
Voter required assistance in completing application due to physical disability.
Assisting person's name:
Assisting person's address:
Signed (under penalty of perjury): Date:
William Francis Galvin
Secretary of the Commonwealth
click to sign
click to edit
dd mmm yyyy
This application may be completed by...
A registered voter; or
A voter’s family member (spouse, roommate, parent, sibling, child, aunt, uncle, niece, nephew,
grandparent, grandchild, in-law).
Use this application to request an absentee ballot for...
A registered voter who will be unable to vote at the polls on Election Day due to absence from
the voter’s city or town during polling hours, disability, or religious beliefs.
A non-registered voter who is:
A Massachusetts citizen absent from the state;
An active member of the armed forces or merchant marines, their spouse or dependent; or
A person conned to a correctional facility or jail for reasons other than felony conviction.
Completing the Application
1. Voter Information – Provide the voter’s name, legal voting address, and date of birth.
Telephone number and e-mail address are optional elds.
2. Ballot Information – Provide the address where you want the ballot mailed and indicate for
which election(s) you are requesting a ballot. For primaries, if the voter is not enrolled in a
party, provide the desired party ballot. Applications for “all elections this year” are valid for one
calendar year.
3. Special Circumstances – Check any of the listed circumstances which apply
to this application, if any.
4. Sign your name. If you require assistance in signing the application, you may authorize
someone to sign your name in your presence. That person must complete the assisting
person’s information in Section 3.
Submitting the Application
Send the completed application to the local election ofcial at the voter’s city or town hall.
Applications can be mailed or hand-delivered. Applications may also be submitted electronically
by fax or e-mail, as long as the requester’s signature is visible.
Please allow ample mailing time for this application and for the ballot. Ballots must be returned to your
local election ofcial by Election Day.
Find contact information for local election ofcials at or by
calling 1-800-462-VOTE (8683).
We certify that the voter for whom this application is being made appears to be eligible to vote from the
address listed on the application.