Gab-121 - Wisconsin Application For Absentee Ballot (Page 2 of 2) in pdf

Wisconsin Application for Absentee Ballot

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 (GAB-131) with this

form.

If you have

not

previously provided a copy of photo

ID,

photo ID must accompany this application. For the full list of

acceptable photo ID visit htto:/lbringit.wLgov. 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 care

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 (GAB-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 humber (including fractions, if any).

• Provide your full street name, including the type (e.g., 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 should 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

• 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

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. Only Military and

Permanent Overseas voters may receive an absentee ballot by email or

fax.

• Military and Permanent Overseas voters may request and access their ballot directly at

https:llmvvote.wi.gov

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

• 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 28 consecutive days

immediately preceding this election, not currently serving a sentence including probation or pa-

role for a felony conviction, and not otherwise disqualified from voting .

GAB-121

Rev 2014-091 GovemmentAccountability

Board, P.O.

Box

7984,

Madison,

53707-79841608-261-20281

web: qab.wi.qov

email:

gab@Wl,gov

Gab-121 - Wisconsin Application For Absentee Ballot Page 2

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