APPLICATION FOR ABSENTEE BALLOT
Education Law Section 2018-b
Applicant’s Name (please print clearly) ____________________________________________________________
Permanent Address ___________________________________________________________________________
Number
and street
___________________________________________________________________________________________
Town State
Zip Code
On the day of the school district election, I am or will be
a qualified voter of the
I will be unable to appear to vote in person that day because (please X the applicable):
_____I will be a patient in a hospital or unable to appear personally at the polling place on that day because of illness or physical disability.
_____ My duties, occupation, business, or studies require me to be outside of my county or town of residence on the day of the election.
a.) Please explain briefly your position and the nature of duties, occupation, business, or studies requiring such absence: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
b.) My duties, occupation, business, or studies are not of such a nature as to ordinarily require such an absence. Please state the circumstances in which an absence is required:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
_____I will be on vacation outside my county or residence on the date of the vote.
a.) Place or places I expect to be on vacation:__________________________________________
b.) Dates when vacation is expected to begin and end:___________________________________
2
Name and address of employer, if any (if self-employed, please state):
________________________________________________________________________ _____________________________________________________________________________________________
_____ I will be absent from my voting residence because I am or will be detained in jail
__________ a.) Awaiting action of a grand jury
__________ b.) Awaiting trial
__________ c.) Confined in prison after conviction for an offense other than a felony
_____ I will be accompanying my spouse/child/parent who is or would be, if he were a qualified voter, entitled to apply for the right to vote by absentee ballot. Please state name, address, and relationship of person referred to in this paragraph:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
I hereby declare that the foregoing is a true statement to the best of my knowledge and belief, and I understand that if I make any material false statement in the foregoing statement of application for absentee ballot, I shall be guilty of a misdemeanor.
_______________________________________________________________________________
Date Signature of voter
Please return to:
District Clerk, Board of Education
c/o Business Administrator
An official ballot will be mailed to your permanent address, unless otherwise indicated below, within five days following receipt of this application.
Please mail ballot to:________________________________________________________________