Request For Early Absentee Voter Ballot

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REQUEST FOR EARLY ABSENTEE VOTER BALLOT for (ONE YEAR ONLY)
(All voters including military and overseas voters must now submit a new request for absentee ballots each year.)
(SUBMIT DIRECTLY by fax, email or mail to the Town Clerk of the town in which you are on the voter checklist.)
FOR Civilian Voters Living in the U.S.:
Voter’s Name:___________________________________________________________ (First, Middle, Last Name)
Check if last name is different than when you registered to vote--Former Name: _________________________
Voter’s Current Mailing Address: __________________________________________________________________
Voter’s Town of Residence: ______________________________________________________________________
Telephone Number: _____________________ Email Address: __________________________________________
(Contact Only - NOT for Ballot Delivery)
I request early absentee voter ballot(s) for the election(s) checked below:
(select Pres. Primary in Presidential Election years)
Annual Town Meeting
All other local elections
August Primary Election
Presidential Primary
November General Election
(1st Tuesday in March) YOU MUST SELECT PARTY:
Democratic Ballot
Republican Ballot
Please deliver the ballot(s) as indicated below (check one):
Mail to voter at: _________________________________________________________________________
Street or PO Box
Town/City
State
Zip Code
Deliver by two Justices of the Peace (This may only be selected if you are ill or physically disabled.)
__________________________________________________
________________
Signature of Absentee Voter or Authorized Person
Date
For Clerks
Voted at town clerk’s office
Date Request Received: ___________
Use Only:
Ballot picked up at town clerk’s office
Date Ballot Mailed: ___________
Date Ballot Returned:
___________
FOR Voters serving in the MILITARY (active U.S. or overseas) and OVERSEAS Voters:
Check one:
Military (Active in U.S. or overseas)
Overseas voter (not military)
Voter’s Name:___________________________________________________________ (First, Middle, Last Name)
Voter’s VT Town of Residence (before joining military or moving overseas): _________________________________
I request early absentee voter ballot(s) for the election(s) checked below:
Annual Town Meeting
August Primary Election
Presidential Primary
November General Election
(1st Tuesday in March) YOU MUST SELECT PARTY:
Democratic Ballot
Republican Ballot
(select Pres. Primary in Presidential Election years)
Please deliver the ballot(s) and all election materials as indicated below (check one):
E-mail Address: __________________________________________________ (Blank ballot will be delivered by
e-mail to the voter. All voted ballots must be mailed or sent by a delivery service to the town clerk.)
Fax to fax number: __________________________________ (You must provide country codes and all other
codes or numbers necessary to fax successfully to the number provided from a VT telephone.)
Regular mail delivery to: (Print exactly as necessary to complete delivery to you.)
_____________________________________________
IF YOUR INFORMATION for the delivery
_____________________________________________
method selected above CHANGES during the
year, you must notify your town clerk of your
_____________________________________________
new contact or delivery information in order
_____________________________________________
to receive your ballots.
_________________________________________________
________________
Signature of Absentee Voter or Authorized Person
Date
IF YOU ARE REQUESTING A BALLOT FOR SOMEONE OTHER THAN YOURSELF, you must complete the
information below: (family member, health care provider, or person authorized by the absentee voter):
Name of Requestor: ______________________________ Signature: _________________________ Date: _________
Organization Name (if applicable): _________________________________________________
Address of Requestor: ___________________________________________________________
Relationship to Voter (check one):
Family member
Health care provider
Person authorized by voter

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