Fillable Absentee Ballot Application Form - Virginia printable pdf download

§§ 24.2-700 and 24.2-701, Code of Virginia

Commonwealth of Virginia

Absentee Ballot Application Form

INSTRUCTIONS

Application for Absentee Ballot

Complete all required information in Parts A-D, and Parts E-F, if applicable. Otherwise, your application cannot be processed.

TOP OF FORM

assistant must write on the voter’s signature line:

Complete the information at the top.

You must…

“Applicant Unable to Sign.”

Assistant must complete and sign

Part E. Assistant should also ensure that the rest of the

· Be a registered voter in the county/city where you are applying.

· Identify the election for which you are applying.

application is complete.

PART A

PART F

To vote absentee, select only one code from the list of reason

· To remain a qualified voter, state law requires you to notify the

codes. Write in the selected code and include any required

General Registrar of a change in your name or address. Complete

information to support the reason (this information

is required by

Part F and sign your name.

state law.) Note: First time voters who registered by mail may vote

absentee by mail only if the reason code in Part A is 1A, 2A, 2C,

ATTENTION VOTERS

6A, 6B, 6C, 6D or 7A, or the voter is 65 or older and qualifies under

another reason.

Apply early! You can apply to vote absentee as early as one

year before the election. You can apply in person at your city

PART B

or county voter registration office or by sending a completed

Print the address where your absentee ballot is to be sent, if voting

application by mail, fax, or a scanned copy. Ballots are available

by mail. The ballot can only be sent to:

45 days before Primary and General elections and 30 days before

· The address where the voter will be while out of their county/city; or

most Special Elections.

· The address where the voter is temporarily confined due to an

illness or disability; or

If applying and voting by mail, allow enough time for your

· The address where the voter is currently registered or newly

application to be processed and your ballot mailed to you.

registered; or

The deadline for applying to vote absentee by mail is 5:00 PM

· The address where the voter is confined awaiting trial or having

the Tuesday before the election. All ballots must be received by

the Electoral Board by 7:00 PM on election day. If returning the

been convicted of a misdemeanor.

· A military or overseas voter (reasons 6A, 6B, 6C or 6D) located

ballot to the Electoral Board in person, only the voter may return it.

outside Virginia may ask to receive their ballot by e-mail or fax.

The deadline for applying and casting your ballot in-person at your

· The ballot cannot be sent “in care of” any other person.

local voter registration office is the Saturday before the election.

PART C

Visit the State Board of Elections website,

· Indicate if assistance

from another person will be needed to

for:

vote the ballot due to the voter’s disability, blindness or inability

· Contact information for your local voter registration office

to read or write. If Yes is checked, an

Assistance Form will be

· Information about absentee voting

sent with the absentee ballot. The form, to be returned with the

· The status of your absentee application

ballot, provides a legal safeguard for the voter and the assistant.

(under Voter Information, Registration Status).

PART D

Toll Free 800 · 552 · 9745 (TTY 800 · 260 · 3466).

· Absentee Voter: Read the Statement in Part D. Then print your

full name, current residence (permanent) home address , social

ATTENTION MILITARY & OVERSEAS VOTERS

security number (last 4 digits required) and a daytime telephone

You are encouraged to use the Federal Post Card Application

number. Sign your name. If applying in person, the application

(FPCA) which also serves as a voter registration application.

must be signed in the presence of a registrar or a member of

To obtain the FPCA form and information, visit

the electoral board. Note: A signature under a power of attorney

Submitting this Virginia Absentee Ballot

cannot be accepted. (Also see Part E.)

Application form will be interpreted as a request by you to

discontinue any pending FPCA. You can submit a new FPCA if

PART E

you are eligible.

· Assistant: if the absentee voter is unable to sign his/her name

due to a disability, blindness or inability to read or write

, the

Privacy Act Notice: Privacy Act Notice: This form collects personal information, including your social security number, for identification and to prevent fraud.

Your application will be denied if you fail to provide the last four digits of your social security number or any other information required to determine your

qualification to vote absentee. Federal law (the Privacy Act) and state law (Va. Code § 24.2-701 and the Government Data Collection and Dissemination Practices

Act) authorize collecting this information and restrict its use to official purposes only.

WARNING: INTENTIONALLY MAKING A MATERIALLY FALSE STATEMENT ON THIS FORM CONSTITUTES THE CRIME OF ELECTION FRAUD, WHICH IS

PUNISHABLE UNDER VIRGINIA LAW AS A FELONY. VIOLATORS MAY BE SENTENCED TO UP TO 10 YEARS IN PRISON, OR UP TO 12 MONTHS IN JAIL AND/OR

FINED UP TO $2,500.