Fill - Free fillable To Request an Absentee Ballot in Wisconsin (City of Verona) PDF form

To Request an Absentee Ballot in Wisconsin…

You will need:

 A copy of your photo ID (see the cheat sheet below and attached sheet)

 The Absentee Request Form (attached here)

Once you have those two items, you can place them in one of our drop boxes at city hall or mail them in

to: City of Verona Elections

111 Lincoln St

Verona, WI 53593

If you have any questions, please call 608-845-6495.

Photo ID Cheat Sheet

Below are the items that are allowed for you to use as photo ID. Please send a copy one of one of them

back with your Absentee Request form:

Wisconsin Driver’s License

Wisconsin ID

Wisconsin License or ID Receipt

Veterans Affairs ID

U.S. Passport

U.S. Uniformed Services

Tribal ID

Certificate of Naturalization

-ACCEPTABLE PHOTO IDS FOR VOTING IN WISCONSIN-

Information Provided by the Wisconsin Elections Commission

Find more information on the Photo ID law at www.BringIt.wi.gov

Contact the Wisconsin Elections Commission at 1-866-Vote-Wis or at elections@wi.gov



Can be expired since Nove

mber 8, 2016

(currently the last General Election)

WHAT PHOTO IDS CAN I USE TO VOTE IN WISCONSIN?

State of Wisconsin Driver License

State of Wisconsin ID Card

Only valid for voting if the

expiration date is no more

than 2 years from the date

the card was issued. Still

valid for voting if expired.

Wisconsin Driver License OR State ID Card Receipt OR

WI DMV ID Petition Process Photo Receipt

Valid for 45 days from the date receipt was issued

OR 180 days for the ID Petition Process Receipt

U.S. Passport Book or Card

Student ID Card

Enrollment Verification

U.S. Uniformed Services

Tribal ID Card

Certificate of Naturalization

Still valid for voting if

expired

Only valid for voting if Certificate

was issued not more than 2 years

before the date of the election

Can be expired since November 8, 2016

(currently the last General Election)

Veterans Affairs ID

Must be unexpired or have

no expiration

Can be expired since

November 8, 2016

(currently the last General Election)

Can be expired since

November 8, 2016

(currently the last

General Election)

Wisconsin Application for Absentee Ballot

Confidential Elector ID#

(HINDI - sequential #) (Official Use Only)

WisVote ID #

(Official Use Only)

Ward No.

Detailed instructions for completion are on the back of this form. Return this form to your municipal clerk when completed.

 You must be registered to vote before you can receive an absentee ballot. You can confirm your voter registration at https://myvote.wi.gov

PHOTO ID REQUIRED, unless you qualify for an exception. See instructions on back for exceptions.

VOTER INFORMATION

Municipality

County

Last Name

First Name

Middle Name

Suffix (e.g. Jr, II, etc.)

Date of Birth

(MM/DD/YYYY)

Phone

Fax

Residence Address: Street Number & Name

Apt. Number

City

State & ZIP

If you are a military or permanent overseas elector, fill in the appropriate circle (see instructions for definitions):

I PREFER TO RECEIVE MY ABSENTEE BALLOT BY:

(Ballot will be mailed to the address above if no preference is indicated.

Absentee ballots may not be forwarded.)

MAIL

Mailing Address: Street Number & Name

VOTE IN

CLERK’S

OFFICE

Apt. Number

City

State & ZIP

Care Facility Name (if applicable)

C / O (if applicable)

FAX

Fax Number

Email Address

I REQUEST AN ABSENTEE BALLOT BE SENT TO ME FOR: (mark only one)

The election(s) on the following date(s): ____________________________________________________________________________

All elections from today’s date through the end of the current calendar year (ending 12/31).

Every election subsequent to today’s date. I further certify that I am indefinitely confined because of age, illness, infirmity or disability and

request absentee ballots be sent to me until I am no longer confined or fail to return a ballot.

TEMPORARILY HOSPITALIZED VOTERS ONLY (please fill in circle)

I certify that I cannot appear at the polling place on election day because I am hospitalized, and appoint the following person to serve as

my agent, pursuant to Wis. Stat. § 6.86(3).

Agent Last Name

Agent First Name

Agent Middle Name

AGENT: I certify that I am the duly appointed agent of the hospitalized absentee elector, that the absentee ballot to be received by me is

received solely for the benefit of the above named hospitalized elector, and that such ballot will be promptly transmitted by me to that elector

and then returned to the municipal clerk or the proper polling place.

Agent Signature

Agent Address

ASSISTANT DECLARATION / CERTIFICATION (if required)

I certify that the application is made on request and by authorization of the named elector, who is unable to sign the application due to physical disability.

Agent

Signature

Today’s Date

VOTER DECLARATION / CERTIFICATION (required for all voters)

I certify that I am a qualified elector, a U.S. Citizen, at least 18 years old, having resided at the above residential address for at least 10 consecutive days

immediately preceding this election, not currently serving a sentence including probation or parole for a felony conviction, and not otherwise disqualified

from voting. Please sign below to acknowledge that you have read and understand the above.

Voter

Signature

Today’s Date

Instructions

Military  Permanent Overseas

-121 | Rev 2016-08 | Wisconsin Elections Commission P.O. Box 7984, Madison, WI 53707-7984 | 608-266-8005 | web: elections.wi.gov | email: elections@wi.gov

Town

Village

City

○

Wisconsin Application for Absentee Ballot Instructions

General Instructions: This form should be submitted to your municipal clerk, unless directed otherwise.

 This form should only be completed by registered voters; if you are not a registered voter or military elector, please submit a Voter

Registration Application (EL-131) with this form.

Photo ID requirement: If you will receive your absentee ballot by mail, and have not previously provided a copy of acceptable photo

ID with a prior by-mail absentee ballot request, a copy of photo ID must accompany this application. You may submit your application

and a copy of your ID by mail, fax or email. In-person voters must always show acceptable photo ID.

The following documents are acceptable Photo ID (For specific information regarding expired documents visit http://bringit.wi.gov.)

State of WI driver license or ID card

Military ID card issued by a U.S. uniformed service

Photo ID issued by the federal Dept. of Veterans Affairs

University, college or tech college ID and enrollment verification

U.S. passport booklet or card

Certificate of Naturalization

WI DOT DL or ID card receipt

Citation/Notice to revoke or suspend WI DL

ID card issued by federally recognized WI tribe

In lieu of photo ID, the voters listed below may satisfy the voter ID requirement by the following means:

 Electors who are indefinitely confined (see Section 6) – the signature of a witness on the Absentee Certificate Envelope.

 Electors residing in care facilities served by Special Voting Deputies – the signatures of both deputies on the envelope.

 Electors residing in care facilities not served by Special Voting Deputies – the signature of an authorized representative of the

facility. If the elector is also indefinitely confined, the elector does not need a representative of the facility to sign.

 Military, Permanent Overseas and Confidential Electors – Exempt from the photo ID requirement.

 Indicate the municipality and county of residence. Use the municipality’s formal name (for example: City of Ashland, Village of Greendale,

or Town of Albion).

 Provide your name as you are registered to vote in Wisconsin. If applicable, please provide your suffix (Jr, Sr, etc.) and/or

middle name. If your current name is different than how you are registered to vote, please submit a Voter Registration

Application (EL-131) with this form to update your information.

 Provide your month, day and year of birth. Remember to use your birth year, not the current year.

 Provide your home address (legal voting residence) with full house number (including fractions, if any).

 Provide your full street name, including the type (eg., Ave.) and any pre– and/or post-directional (N, S, etc.).

 Provide the city name and ZIP code as it would appear on mail delivered to the home address.

 You may not enter a PO Box as a voting residence. A rural route box without a number may not be used.

 A “Military elector” is a person, or the spouse or dependent of a person who is a member of a uniformed service or the

merchant marines, a civilian employee of the United States, a civilian officially attached to a uniformed service and serving

outside the United States, or a Peace Corp volunteer. Military electors do not need to register to vote.

 A “Permanent Overseas elector” is a person who is a United States citizen, 18 years old or older, who resided in Wisconsin

immediately prior to leaving the United States, who is now living outside the United States and has no present intent to return,

who is not registered in any other location, or who is an adult child of a United States citizen who resided in this state prior to

establishing residency abroad. Permanent Overseas electors will receive ballots for federal offices only and must be registered

to vote prior to receiving a ballot.

 Fill in the circle to indicate your preferred method of receiving your absentee ballot.

Military and Permanent Overseas voters may request and access their ballot directly at https://myvote.wi.gov.

 If no preference is indicated, your absentee ballot will be mailed to your residence address listed in Box 3.

 You are encouraged to provide a physical mailing address as backup in case of electronic transmission difficulties. Please only

fill the circle for your preferred means of transmission.

 If you are living in a care facility, please provide the name of the facility.

 If someone will be receiving the ballot on your behalf, please list them after C/O. Please note: The absentee elector is still

required to vote their own ballot, although they may request assistance in physically marking the ballot.

 Select the first option if you would like to receive a ballot for a single election or a specific set of elections.

 Select the second option if you would like to have a standing absentee request for any and all elections that may occur in a

calendar year (ending December 31).

 Select the third option only if you are indefinitely confined due to age, illness, infirmity or disability and wish to request absentee

ballots for all elections until you are no longer confined or fail to return a ballot for an election.

 This section is only to be completed by an elector or the agent of an elector who is currently hospitalized.

 An agent completing this form for a hospitalized elector must provide his/her name, signature and address on this application.

Assistant Signature:

In the situation where the elector is unable to sign the Voter Declaration / Certification due to a physical

disability, the elector may authorize another elector to sign on his or her behalf. Any elector signing an

application on another elector's behalf shall attest to a statement that the application is made on request

and by authorization of the named elector, who is unable to sign the application due to physical disability.

Voter Signature:

By signing and dating this form, you certify that you are a qualified elector, a U.S. citizen, at least 18 years

old, having resided at your residential address for at least 10 consecutive days immediately preceding this

election, not currently serving a sentence including probation or parole for a felony conviction, and not

otherwise disqualified from voting.

EL-121 | Rev 2016-08 | Wisconsin Elections Commission P.O. Box 7984, Madison, WI 53707-7984 | 608-266-8005 | web: elections.wi.gov | email: elections@wi.gov

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