FORMULARIO DE SOLICITUD PARA LA BOLETA-POR-CORREO Y …€¦ · AFSCME 1625 L Street, NW...

AFSCME1625 L Street, NWWashington, DC 20036

AFSCME2001

Sign up to Vote by Mail today. Application attached.

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AFSCMEMEMBERS VOTEOUR COMMUNITIES ARE STRONGEST

BALLOT-BY-MAIL & PERMANENT EARLY VOTING LIST REQUEST FORMFORMULARIO DE SOLICITUD PARA LA BOLETA-POR-CORREO Y LA LISTA PERMANENTE DE VOTACIÓN TEMPRANA

Use this form: (1) to request a ballot-by-mail for the Primary and/or General Election; or (2) to be added to the Permanent Early Voting List (PEVL) and automatically receive a ballot-by-mail for every election. Complete, sign, and return this form by mail, fax, or email to your County Recorder (contact information: azsos.gov/county-election-info). Your request must be received by 5:00 p.m. on the 11th day before the election to receive a ballot-by-mail for that election.

Use este formulario: (1) para solicitar una boleta-por-correo; o (2) para ser incluido en la Lista Permanente de Votación Temprana y recibir automáticamente una boleta-por-correo para cada elección. Llene, firme, y devuelva por correo, email, o fax este formulario al Registrador de su Condado (datos de contacto: azsos.gov/county-election-info). Para recibir una boleta-por-correo para una election, el Registrador de su Condado debe recibir su solicitud antes de las 5:00 p.m., 11 dias antes del dia de la elección.

* Starred boxes are required. / Cajas con un asterisco son obligatorios.

First and Last Name / Nombre y Apellido

Provide your place of birth, driver’s license #, or last 4 digits of SSN# Proporcione su lugar de nacimiento, # de licencia, o los cuatros dígitos pasados de su # de seguridad social

Residence Address / Domicilio Residencial

County of Residence / Condado de Domicilio

Questions? / ¿Preguntas? 1-877-THE-VOTE or [email protected]

Mailing Address (if different from residence address) / Dirección Postal (si es diferente a su domicilio)

Date / Fecha Phone Number / Número de Teléfono

Date of Birth / Fecha de Nacimiento Email Address / Correo Electrónico

Check this box if you request the County Recorder change your residence and mailing address on your registration record to the ones listed above. / Marque esta casilla si solicita al Registrador del Condado que cambie su domicilio y dirección postal en su registro electoral a los que están enumerados arriba.

Former address / Dirección anterior

Check this box if you request the County Recorder change your name on your registration record to the one listed above. / Marque esta casilla si usted solicita que el Registrador de su Condado cambie su nombre en su registro electoral por el que aparece arriba.

Former name / Nombre anterior

Primary Election Ballot Selection: Select a party or nonpartisan ballot for the Primary Election. This will not change your voter registration to this political party affiliation. / Selección de boleta para la Elección Primaria: Seleccione una boleta de un partido politico o una boleta no partidista para la Elección Primaria. Esta selección no cambiara su registro de votante a esta afiliación del partido politico.

Green (Pima County Voters Only) Verde (Sólamente para los Votantes del Condado de Pima)

Democratic Demócrata

Municipal-Only: NonpartisanSólo Municipal: No partidista

Republican Republicano

I am requesting a ballot for: / Estoy solicitando una boleta para:*1

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*5

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*11

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*13

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Every Election. I authorize the County Recorder to include my name on the PEVL and automatically send me a ballot-by-mail for each election I am eligible for. / Todas las Elecciones. Autorizo al Registrador del Condado a incluir mi nombre en la Lista Permanente de Votación Temprana y a enviarme automáticamente una boleta-por-correo para cada elección para la cual yo sea elegible.

Primary & General ElectionAmbas Eleccciones: Primaria y General

Primary Election OnlySólamente para la Elección Primaria

General Election Only Sólamente para la Elección General

By signing below, I swear or affirm that I am a registered voter in my county of residence and that the above information is true and correct. / Al firmar abajo, yo juro o afirmo que soy un votante registrado en mi condado de residencia y que la información anterior es verdadera y corecta.

X

Independent Voters Only

Sólamente para los Votantes Independientes

To update your registration

Para actualizar su registro

FIRST-CLASS MAILU.S. POSTAGE

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Fold here and tape with two pieces on the top edge near the left and right hand edges.

This November public service workers must stand together, and in 2020 you can vote by mail safely and securely from the comfort of your own home. Voting by mail will help make sure all our voices are heard in this election.

If you haven’t already requested a ballot, fill out the attached form.

Clip out the form, fold it, and mail to your local election office (the postage is prepaid). Make sure to return your application promptly.

Once you receive your ballot, mark your vote, and mail back in immediately.

AFSCME URGES YOU TO

VOTE BY MAILSO ALL OUR VOICES ARE HEARD

VISIT AFSCME.ORG/VBM TO UTILIZE OUR SECURE VOTE BY MAIL TOOL.

VOTING BY MAIL IS: SAFESECUREAND EFFECTIVE

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Return Address Line 1Return Address Line 2Return Address Line 3


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First Name: Middle Name/Initial: Last Name:

Date of Birth: / / (required)

FLORIDA RESIDENCE ADDRESS (REQUIRED)Street Address: Apt/Unit/Lot:

City: State: Zip Code:

PERMANENT MAILING ADDRESS (IF DIFFERENT FROM RESIDENCE ADDRESS)Street Address: Apt/Unit/Lot:

City: State: Zip Code:

BALLOT REQUEST IS FOR (SELECT CHOICE THAT APPLIES)

All elections for which I am eligible to vote through the calendar year of the second regularly scheduled general election (2022).

Specific Election (current year):

ALTERNATIVE MAILING ADDRESS (IF DIFFERENT FROM RESIDENTIAL/MAILING ADDRESS)Note: If "All Elections" was selected above, all ballots will be mailed to the alternative mailing address unless otherwise specified below.

Specific Election:

Alt. Mailing Address: Apt/Unit/Lot:

City: State/Country: Zip Code:

REQUEST BY IMMEDIATE FAMILY MEMBER OR LEGAL GUARDIAN FOR VOTERA voter can designate an immediate family member (the designee's spouse or the parent, child, grandparent, or sibling of the designee or of the designee's spouse) or the voter's legal guardian to request the ballot on their behalf. The following additional information is required for the request:

I have been instructed by the voter to make this request.

Requester's Name: Relationship to the Voter (Required):

Requester's Complete Address:

Requester's Driver's License Number (if available)

SIGNATURE REQUIRED:

VOTE-BY-MAIL BALLOT REQUEST FORM


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Iowa Driver’s License or Non-Operator ID Number: OR

FOR OFFICE USE ONLY

Y�� N�� D�� B��

Middle

Suffix

ID N��

Y�� I�� R�� A�� You must be registered to vote in the county to receive an absentee ballot. If you are registered to vote in the county, this form will be used to update

your voter registration if the information provided on this form is different than the information on your registration record.

Home Street Address (include apt, lot, etc. if applicable)

City Zip County

W�� Y�� A�� B�� S�� B� M�� If different than above

Mailing Address/P.O. Box

Phone Email

General Primary City/School Special: OR

DO NOT ADD THIS INFORMATION TO MY VOTER RECORD

Elec�on Date:

Check one poli�cal party Democra�c Republican

R�� A�� Powers of a�orney do not have legal authority to request an absentee ballot on behalf of another.

I swear or affirm that I am the person named above and I am a registered voter or I am entitled to register at the address listed on this form. I am eligible to receive and vote an absentee ballot for the election indicated above.

Signature: X Date

STATE OF IOWA OFFICIAL ABSENTEE BALLOT REQUEST FORM

City State Zip

Country (other than USA)

CCoommpplleettee oonnee

Date of Birth (month, day, year)

First

Last

Voters who do not appear in the Iowa Dept. of Transporta�on’s Driver’s License or Non-Operator ID files are mailed an Iowa Voter Iden�fica�on Card at the �me of registra�on. Any voter may request a Voter Iden�fica�on Card.

/ /

/ /

C�� I�� Important

P�� E�� O��

E�� D�� T��Choose only one elec�on

Revised July 2020

Four-digit Voter PIN (found only on Voter Iden�fica�on Card):

ABSENTEE BALLOT REQUEST FORM INSTRUCTIONSA registered voter may make written application to their County Auditor for an absentee ballot. A written application for a mailed absentee ballot must be received by the voter's County Auditor no later than 5:00 p.m. 10 days before a General Election or 11 days before any other election.

In order to receive an absentee ballot, a registered voter MUST provide the following necessary information:

1. Name2. Date of birth3. Iowa residential address4. Voter Verification Number (ID Number)

- Iowa Driver's License or Non-Operator ID Number OR- Four digit Voter PIN located on the voter's Iowa Voter ID Card- Any voter may request an Iowa Voter ID Card by contacting their County

Auditor's Office5. The name OR date of the election for which you are requesting an absentee ballot6. Party affiliation - only required for Primary Elections, which are held in even numbered

years7. Signature

All voters are encouraged to provide their phone number and/or email address in the event their County Auditor needs to confirm any information on the request form.

If you have questions about absentee voting, please contact your County Auditor.


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2020 Michigan Absent Voter Ballot Application

First Name M.I. Last Name County ❑City❑Township

Street Address Jurisdiction

MI City Zip Year of Birth

( ) Email Address Phone #

Enter your information as it appears on your voter registration. Your email address and phone number help your clerk contact you if there is a problem with your application or ballot. They are used only for election purposes and providing them is optional.

Select election(s) to receive ballot (required):NNoovveemmbbeerr 33, 2020 General Election AAuugguusstt 44, 2020 Primary

Both 22002200 Elections

Future Elections: Complete to join permanent list

I want to vote absentee in all future elections. Automatically send me an application for every election.

I certify that I am a United States citizen and a qualified and registered elector of the Michigan city or township listed above, and I apply for an official ballot, to be voted by me in the election(s) checked above, and the statements in this application are true.

X / / Voter’s Signature (Voter must sign - power of attorney is not acceptable) DateWARNING: You must be a United States citizen to vote. If you are not a United States citizen, you will not be issued an absent voter ballot. A person making a false statement in this absent voter ballot application is guilty of a misdemeanor. It is a violation of Michigan election law for a person other than those listed in the instructions to return, offer to return, agree to return, or solicit to return your absent voter ballot application to the clerk. An assistant authorized by the clerk who receives absent voter ballot applications at a location other than the clerk’s office must have credentials signed by the clerk. Ask to see his or her credentials before entrusting your application with a person claiming to have the clerk’s authorization to return your application.

Want your ballot mailed to different address than you wrote above? [USPS won’t forward it] Aug 4 Primary Date leaving for this address:

/ / Date of return:

/ /

Nov 3 General Date leaving for this address:

/ / Date of return:

/ /

Street Address Street Address

City State Zip City State Zip

Return this to your city/township clerk. Find their contact info at Michigan.gov/Vote.

Complete only if helping a voter return application

Certificate of Authorized Registered Elector Assisting in Returning Application: I certify that my name is _________________________________________, date of birth is ____/____/____ and address is _________________________________________________________; that I am delivering the absent voter ballot application of _______________________________________at his or her request; I did not solicit or request to return the application or make any markings on or alter it; I did not influence the applicant; I understand that a false statement in this certificate is a violation of Michigan election law.X_______________________________________ ____/____/____

Signature of person assisting the voter Date

S E E O T H E R S I D E F O R M O R E I N S T R U C T I O N S

Complete

Sign

Other

Check

Return

Check

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Clerk’s Use Only Primary General

Wd/Pct Mailed / / Returned / / Mailed / / Returned / /

Filed / / Ballot No: Clerk Ballot No: Clerk


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Clip out the form, fold it, and mail to your local election office (the postage is prepaid). Find your clerk's address at mvic.sos.state.mi.us/clerk


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Clerk: Elections


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2020 Minnesota Absentee Ballot Application Apply online at https://www.mnvotes.org ORComplete lines 1 through 7 below. Please print clearly. Return this application as soon as possible. Ballots must be returned by election day to be counted.Important: Active duty military and overseas voters should not use this application. See the other side for more information.

1. absentee ballots requested for the following election(s) (if no election is marked, a ballot will be mailed for the next election only)

2/11 Special Election 3/10 Township Election

4/14 Special Election 5/12 Special Election

8/11 Primary Election 11/3 General Election

Both 8/11 & 11/3 Elections Other (specify date):

2. last name or surname first name middle name suffix

3. date of birth (mm/dd/yyyy) county where you live phone number

email address

4. mark all boxes that apply:I have a MN-issued driver’s license or MN ID card. The number is:

I have a social security number. The last four digits are: XXX-XX-I do not have a MN-issued driver’s license, MN-issued ID card or a social security number.

Your identification number will be compared to the one on your absentee ballot envelope.

5. address where you live (residence) apt. city MN

zip code

6. address where your absentee ballot should be sent apt. city state zip code

7. I certify that I:

am completing this application on my own behalf; will be at least 18 years old on election day; am a citizen of the United States; will have resided in Minnesota for 20 days immediately preceding election day; maintain residence at the address given on this application form; am not under court-ordered guardianship in which the court order revokes my right to vote; have not been found by a court to be legally incompetent to vote; have the right to vote because, if I have been convicted of a felony, my felony sentence has expired (been completed) or I

have been discharged from my sentence; and have read and understand this statement: The above information is accurate, and I sign this application form under penalty

of perjury, a felony punishable by not more than 5 years imprisonment, a fine of not more than $10,000, or both.

school district

precinct reg non-reg

official use only received date initials

ballot issued date reg non-reg

Primary

General received date initials

ballot issued date type

M C HCF

type

M C HCF

repl. date: reason replaced

rejected lost spoiled never received

repl. date: reason replaced

rejected lost spoiled never received

See other side for special instructions for voters with disabilities or power of attorney.

sign here: X__________________________ date ____/____/____

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Date of Birth

State Zip Code

X X

2020 STATE ABSENTEE BALLOT REQUEST FORM (Read the instructions before completing this form. Items in red are required.)

FRAUDULENTLY OR FALSELY COMPLETING THIS FORM IS A CLASS I FELONY UNDER CHAPTER 163 OF THE NC GENERAL STATUTES

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Last Name First Name Middle Name Suffix

/ /

Previous Last Name Previous First Name Previous Middle Name NC DL or ID Number Last Four Digits of Social Security number

Current NC Residential Street Address

City County

Have you lived at this address for 30 or more days? Yes No

If “No”, date moved?

/ /

Provide your mailing address if you do not receive mail at your residential address.

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Absentee Mailing Address (where you would like your ballot sent)

Mailing City State Zip Code

Near Relative or Legal Guardian Request: If you are requesting an absentee ballot on behalf of a near relative or for someone for whom you are the legal guardian, provide your name, relationship to the voter (see instructions), address and contact information. Near Relative or Legal Guardian’s Name Your Relationship to Voter

Near Relative or Legal Guardian’s Address City State Zip Code

Voter Assistance: If the voter received assistance completing this form due to blindness, disability, or inability to read or write and no near relative or legal guardian of the voter was available, list the name and address of the person assisting the voter with completing this form. Voter Assistant’s Name

Address City State Zip Code

If voter is a patient in a hospital, clinic, nursing home or rest home, does voter need assistance with voting and returning the ballot? Yes No If Yes, what is the name and address of the hospital or facility?

3 M

ilitar

y &

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Are you an absentee military or overseas voter? If so, select the best option below that describes your absentee status: Member of the Uniformed Services or Merchant Marine on active duty or eligible spouse/dependent and currently absent from county of residence U.S. citizen outside the United States

Provide the address where you are currently stationed or living overseas. Send your ballot by mail? (provide address)

Send your ballot by email? (provide email address) Send your ballot by fax? (provide #)

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Voter’s Signature Near Relative or Legal Guardian Signature (if applicable)

Date Date

SBOE 2020.04

OR

E-mail Phone

Please provide your email address or a telephone number in case we have a question concerning this request.

Election Date: November 3, 2020

Check if you would like to request absentee ballots for all elections held during this calendar year in which you are eligible to vote due to continued or expected illness or disability.


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Use black ink

Print your name Please print your name exactly as you registered to vote. 1

Last name

First name

Jr Sr II Ill IV (circle if applicable)

Middle name or initial

About youPhone and email are optional and used if information is missing on this form.

2Birth date M M / D D / Y Y Y Y

Phone - - Email

Your addressPlease print your address exactly as you registered to vote.

3

Address (not P.O. Box) Apt. number

City/Town State PA Zip code

Municipality County

Ward (if known) Voting district (if known)

I have lived at this address since:

Where to mail ballot? 4

Same as above Address or P.O. Box

City/Town State Zip code

IdentificationIf you have a PennDOT number,you must use it. If not, please provide the last four digits of your Social Security number. See “Necessary Identification” on Page 2.

5

PA driver's license or PennDOT ID card number

Last four digits of your Social Security number X X X - X X -

I do not have a PA driver’s license or a PennDOT ID card or a Social Security number.

Declaration6

I declare that I am eligible to vote by mail-in ballot at the forthcoming primary or election; that I am requesting the ballot of the party with which I am enrolled according to my voter registration record; and that all of the information which I have listed on this mail-in ballot application is true and correct.

Voter signature here X Date

Annual mail-in requestSee “What is an annual mail-in ballot request?” for more information.

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If you would like to apply to receive mail-in ballots for the remainder of this year and if you would like to automatically receive an annual application for mail-in ballots each year, please indicate below.

I would like to receive mail-in ballots this year and receive annual applications for mail-in ballots each year.

Help with this formComplete this section if you are unable to sign the declaration in Section 6.

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I hereby state that I am unable to sign my application for a mail-in ballot without assistance because I am unable to write by reason of my illness or physical disability. I have made or have received assistance in making my mark in lieu of my signature.

Mark of voter X Date

Address of witness

Signature of witness X

DOS-12/2019

Pennsylvania Application for Mail-In Ballot

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EL-121 | Rev 2020-06 | Wisconsin Elections Commission, P.O. Box 7984, Madison, WI 53707-7984 | 608-266-8005 | web: elections.wi.gov | email: [email protected]

○ ○ ○ ○

Wisconsin Application for Absentee Ballot (Municipal Clerk) If in-person voter, check here:

Absentee ballots may also be requested at MyVote.wi.gov

Confidential Elector ID# (HINDI - sequential #) (Official Use Only)

WisVote ID # (Official Use Only)

Ward No.

Detailed instructions for completion are on the back of this form. Return this form to your municipal clerk when completed. • You must be registered to vote before you can receive an absentee ballot. You can confirm your voter registration at https://myvote.wi.gov

PHOTO ID REQUIRED, unless you qualify for an exception. See instructions on back for exceptions.

VOTER INFORMATION

1 Municipality

County

2

Last Name

First Name

Middle Name

Suffix (e.g. Jr, II, etc.)

Date of Birth (MM/DD/YYYY)

Phone

Fax

Email

3

Residence Address: Street Number & Name

Apt. Number

City

State & ZIP

4

Fill in the appropriate circle – if applicable (see instructions for definitions): Military Permanent Overseas Temporary Overseas

I PREFER TO RECEIVE MY ABSENTEE BALLOT BY: (Ballot will be mailed to the address above if no preference is indicated. Absentee ballots may not be forwarded.)

5

MAIL

Mailing Address: Street Number & Name

VOTE IN CLERK’S OFFICE

Apt. Number

City State & ZIP

Care Facility Name (if applicable)

C / O (if applicable)

FAX

Fax Number For Military and Overseas Voters Only

Voter must have a computer and printer when receiving a ballot by fax or email. Voted ballots must be returned by mail. EMAIL Email Address

For Military and Overseas Voters Only

I REQUEST AN ABSENTEE BALLOT BE SENT TO ME FOR: (mark only one)

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The election(s) on the following date(s): ____________________________________________________________________________ All elections from today’s date through the end of the current calendar year (ending 12/31). For indefinitely-confined voters only: I certify that I am indefinitely confined because of age, illness, infirmity or disability and request absentee ballots be sent to me automatically until I am no longer confined, or I fail to return a ballot. Anyone who makes false statements in order to obtain an absentee ballot may be fined not more than $1,000 or imprisoned not more than 6 months or both. Wis. Stats. §§ 12.13(3)(i), 12.60(1)(b).

TEMPORARILY HOSPITALIZED VOTERS ONLY (please fill in circle)

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I certify that I cannot appear at the polling place on election day because I am hospitalized, and appoint the following person to serve as my agent, pursuant to Wis. Stat. § 6.86(3).

Agent Last Name

Agent First Name

Agent Middle Name

AGENT: I certify that I am the duly appointed agent of the hospitalized absentee elector, that the absentee ballot to be received by me is received solely for the benefit of the above named hospitalized elector, and that such ballot will be promptly transmitted by me to that elector and then returned to the municipal clerk or the proper polling place.

Agent Signature

X

Agent Address

ASSISTANT DECLARATION / CERTIFICATION (if required)

I certify 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.

Agent Signature

X

Today’s Date

VOTER DECLARATION / CERTIFICATION (required for all voters)

I certify that I am a qualified elector, a U.S. Citizen, at least 18 years old, having resided at the above residential address for at least 28 consecutive days immediately preceding this election, not currently serving a sentence including probation or parole for a felony conviction, and not otherwise disqualified from voting. Please sign below to acknowledge that you have read and understand the above.

Voter Signature

X

Today’s Date

Instructions

Town

Village

City

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○

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Clip out the form, fold it, and mail to your local election office (the postage is prepaid). Find your clerk's address at myvote.wi.gov/en-us/VoteAbsentee


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Clerk: Elections

FORMULARIO DE SOLICITUD PARA LA BOLETA-POR-CORREO Y …€¦ · AFSCME 1625 L Street, NW...

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Transcript of FORMULARIO DE SOLICITUD PARA LA BOLETA-POR-CORREO Y …€¦ · AFSCME 1625 L Street, NW...