Fillable Voter Registration And Absentee Ballot Request PDF (Township of Berkeley Heights)

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Voter Registration And Absentee Ballot Request PDF (Township of Berkeley Heights)

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Country of origin: US
File type: PDF

U.S.A. forms for Township of Berkeley Heights

BROWSE TOWNSHIP OF BERKELEY HEIGHTS (NJ) FORMS

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M M
D
D
Y Y Y Y
See instructions
To vote in primary elections, your State may require you to specify a political party:
Email
Federal Post Card Application (FPCA)
Voter Registration and Absentee Ballot Request
County
Previous name (if applicable)
5
7
Identication
Some States require your
full SSN. Check your State’s
pages in the Voting Assistance
Guide on FVAP.gov.
Contact
information
Include international
prexes. No DSN number.
Political Party
Ballot receipt
2
6
4
– –
Last name
First name
Sufx
Apt. #
3
Your legal name
City/Town/Village
Street Address (not P.O. Box)
U.S. address for
voting purposes
Usually your last U.S.
residence or your legal U.S.
residence. See instructions.
Address where
you live now
This is different from above.
Your voting materials
will be sent here, unless
you specify a forwarding
address in Box 9.
8
9
This information is for ofcial use only. Any unauthorized release may be punishable by law.
Please print in black ink.
1
Classication
Make only 1 selection.
(In most States, you must be
absent from your voting district
to use this form).
I am a U.S. citizen residing outside the U.S., and I intend to return.
I prefer to receive my ballot, as permitted by my State, by:
(rank from 1 -3 in order of preference; be sure appropriate contact information is provided above)
I am a member of the Uniformed Services or Merchant Marine on active duty OR
Standard Form 76 (Rev. 08-2011)
M F
Birth date
/ /
Additional
requirements
for your State
Such as: mail forwarding
address, additional phone,
or other State required
information. See your
State’s pages in the
Voting Assistance Guide
on FVAP.gov.
D D
/ /
M M Y Y Y Y
Signature Print this form, sign, and send in.
Afrmation (REQUIRED): I swear or afrm, under penalty of perjury, that:
• I am a member of the Uniformed Services or Merchant Marine on active duty or an eligible spouse
or dependent of such a member, or a U.S. citizen temporarily residing outside the U.S., or other U.S.
citizen residing outside the U.S. • I am a U.S. citizen, at least 18 years of age (or will be by the day
of the election), eligible to vote in the requested jurisdiction. • I have not been convicted of a
felony or other disqualifying offense or been adjudicated mentally incompetent, or if so, my voting
rights have been reinstated. • I am not registering, requesting a ballot, or voting in any other
jurisdiction in the U.S. • My signature and date herein indicate when I completed this document.
• The information on this form is true and complete to the best of my knowledge. I understand that a
material misstatement of fact in completion of this document may constitute grounds for conviction
of perjury.
Witness signature / date if required by your State.
See the Voting Assistance Guide on FVAP.gov.
Middle name
I am their spouse or dependent.
Email/Online
Sex
Telephone
Fax
State
Zip Code
OR Social Security Number
State Driver’s License or ID
Mail Fax
Today’s date
Alternate Email
–
Signature
Date
A quicker, easier to complete, electronic version of this
form is also available on FVAP.gov. For any questions
about this form, consult your Voting Assistance Ofcer or
the Voting Assistance Guide available in hard copy or on
FVAP.gov.
Race
I am a U.S. citizen otherwise granted military/overseas voting rights under State law (check the Voting Assistance Guide).
I am a U.S. citizen residing outside the U.S., and I do not intend to return.
I request an absentee ballot for all elections in which I am eligible to vote AND:
Print Form
The gray numbers and instructions below correspond to the gray
numbered boxes on the face of the form.
1
Theclassicationyouchoosedeterminesinwhichelection(s)youwillbe
allowed to vote. Choose the one that best represents your current situation.
2
If you want to vote in primary elections, most States require you to specify a
political party. Check your State’s pages in the Voting Assistance Guide on
FVAP.gov to see if your State requires you to specify a political party.
3
The information you enter for your name should match the information you
normallyputonlegalorofcialforms.Forexample,itshouldbethesame
name that appears on your driver’s license or other government-issued ID.
4
While most States allow you to enter either your driver’s license number
or the last 4 digits of your Social Security Number, some will invalidate
this form without your full SSN. Check your State’s pages in the Voting
Assistance Guide on FVAP.gov to see if your State requires the full SSN.
Also, many States ask that you provide your race or ethnic group in order
to demonstrate that they are complying with the Voting Rights Act and the
National Voter Registration Act.
5
Iftherearequestionsorproblemswithyourform,localelectionofcialswill
use this information to contact you. An email address is the simplest and
fastest way for them to do so. Your voting materials will be sent to the email
address(es)thatyouprovidehereifyourequestitandyourStateallowsit.
Include an alternate phone number in Box 9 if necessary.
6
Indicate your preferred method for receiving your ballot by ranking each box
1, 2, or 3. All States and jurisdictions must send absentee ballots to military
and overseas voters by at least one of the following: email, online download,
or fax if requested. Check your State’s pages in the Voting Assistance
Guide on FVAP.gov to learn what your State allows. You can always get
your absentee ballot by mail.
7
This determines the jurisdiction where you vote. For military voters the
voting address is your legal U.S. residence. For overseas citizens this is
usually the U.S. address where you last lived. You do not need to have any
current physical ties to this address.
Donotuseapostofceboxnumber.If
the area has no street names, enter the route number and box number.
8
Enter the address where you want voting materials to be sent to you. Voting
materials will be sent to this address unless you enter a forwarding address in
Box 9.
9
Enter anything here that would help ensure that your ballot is accepted. Check
your State’s pages in the Voting Assistance Guide on FVAP.gov for anything
yourStatemayspecicallyrequirehere.Forexample,someStatesrequire
last date of residency in the U.S., previous location of registration, overseas
employer, or witness address.
If you want your voting materials to be sent somewhere other than where you
livenow,enterthatalternate(forwarding)addresshere.Provideanalternate
phone number here.
Afrmation.Readthiscarefully.Itiswhatyouareagreeingtounderoathand
penaltyofperjurybyllingoutandsendinginthisform.SomeStatesrequire
that your form be witnessed. Check the Voting Assistance Guide on FVAP.
gov for your State’s requirements.
FederalPostCardApplication(FPCA)
Instructions
From
(Yournameandcurrentcompletemilitaryoroverseasmailingaddress)
To
(CheckyourState’spagesintheVotingAssistanceGuideonFVAP.govforyourlocalelection
ofcial’sinformation)
International airmail postage is required if not mailed in the
U.S. Postal Service, APO/FPO system, or diplomatic pouch.
U.S. Postage Paid
39 USC 3406
OFFICIAL ABSENTEE BALLOTING MATERIAL – FIRST CLASS MAIL
PAR AVION
NO POSTAGE NECESSARY IN THE U.S. MAIL – DMM 703.8.0
Privacy Act Statement
Authority: The authority to collect your personal information on this form comes
from 42 USC 1973ff, “Uniformed and Overseas Citizens Absentee Voting Act
(UOCAVA).”
Principal Purpose: This form serves as an application for registration and/or
request for absentee ballot for all persons covered by UOCAVA.
Disclosure: Your disclosure of personal information is voluntary. However, failure
to provide the requested personal information may keep the pertinent jurisdiction
from processing this request and may prevent you from voting absentee.
A quicker, easier to complete, electronic version of this form is also
available on FVAP.gov. For any questions about this form, consult
yourVotingAssistanceOfcerortheVotingAssistanceGuide
available in hard copy or on FVAP.gov.
StandardForm76(Rev.08-2011)
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Voter Registration And Absentee Ballot Request PDF (Township of Berkeley Heights)

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Completed 21 July 2020

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