1/4/18
South Dakota Absentee Ballot Application Form
_____________________ County
Please print and return to your county auditor. A new application must be completed each calendar year.
You may apply for an absentee ballot before 5:00 p.m. the day before the election for any or all general, primary, municipal, school, or any other
elections conducted in this calendar year with one request. Additional information on absentee voting is available at sdsos.gov.
1
Last Name
First Name
Middle Name(s)/Initial
Suffix
2
Voter Registration Address
Apt. or Lot #
City, State
Zip Code
3
Absentee ballot mailing address (if different from Section #2)
City, State
Zip Code
SELECT THE ELECTION(S) YOU ARE REQUESTING AN ABSENTEE BALLOT FOR: If your address changes after this is submitted, you must submit a new form
5
Daytime telephone number
If request is for a municipal or school election:
I have lived in that jurisdiction at least 30 days in the last year. YES NO
I am a full-time student who resided in that jurisdiction prior to leaving. YES NO
MILITARY AND OVERSEAS CITIZENS ONLY:
6
7
AUTHORIZED MESSENGER REQUEST DUE TO SICKNESS OR DISABILITY ONLY: The deadline to request is 3:00 p.m. on Election Day
8
Last Name
First Name
Daytime telephone
Address
Apt. or Lot #
City, State
Zip Code
...to serve as my authorized messenger to pick up my absentee ballot. I
further certify under penalty of law that I am confined because of
sickness or disability and for this reason alone am unable to vote at my
polling place on Election Day.
Voter’s Signature
As the authorized messenger, I acknowledge receipt of the ballot for
the above named voter on…Date: ____________Time:____________
Are you serving as an authorized messenger for any other voter?
YES NO
Authorized Messenger’s Signature
4
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