Michigan Absent Voter Ballot Application: November 3, 2020 Election
First Name M.I. Last Name
Enter your information as it appears on your voter registration. Your email address and phone number help your clerk contact you if there
is a problem with your application or ballot. They are used only for election purposes and providing them is optional.
Future Elections: Complete
to join permanent list
I want to vote absentee in all future elections.
Automatically send me an application for every election.
I certify that I am a United States citizen and a qualified and registered elector of the Michigan city or township listed above, and I
apply for an official ballot, to be voted by me in the election(s) checked above, and the statements in this application are true.
X / /
Voter’s Signature (Voter must sign - power of attorney is not acceptable) Date
WARNING: You must be a United States citizen to vote. If you are not a United States citizen, you will not be issued an absent voter ballot. A person making a
false statement in this absent voter ballot application is guilty of a misdemeanor. It is a violation of Michigan election law for a person other than those listed in the
instructions to return, offer to return, agree to return, or solicit to return your absent voter ballot application to the clerk. An assistant authorized by the clerk who
receives absent voter ballot applications at a location other than the clerk’s office must have credentials signed by the clerk. Ask to see his or her credentials before
entrusting your application with a person claiming to have the clerk’s authorization to return your application.
Want your ballot mailed to different address than you wrote above? [USPS won’t forward it]
Date leaving for
this address:
/ /
Date of return:
/ /
Street Address
City State Zip
Return this to your city/township clerk. Find their contact info at Michigan.gov/Vote.
Complete only
if helping a
voter return
application
Certificate of Authorized Registered Elector Assisting in Returning Application:
I certify that my name is _________________________________________, date of birth is ____/____/____
and address is _________________________________________________________; that I am delivering
the absent voter ballot application of _______________________________________at his or her request; I
did not solicit or request to return the application or make any markings on or alter it; I did not influence the
applicant; I understand that a false statement in this certificate is a violation of Michigan election law.
X_______________________________________ ____/____/____
Signature of person assisting the voter Date
S E E O T H E R S I D E F O R M O R E I N S T R U C T I O N S
Sign
Other
Check
Return
Check
5
4
3
2
Clerk’s Use Only Primary General
Wd/Pct Mailed / / Returned / / Mailed / / Returned / /
Filed / / Ballot No: Clerk Ballot No: Clerk
