EARLY BALLOT REQUEST FORM

(formerly Absentee Ballot)

 

  Print this form, complete the form and then either mail, fax or deliver in person to:

                        Diane M. Olmer, Platte County Election Commissioner

                        P.O. Box 513

                        2610 14th Street

                        Columbus, NE 68602-0513

                        Phone: 402 563-4908

                        Fax:     402 564-7733)                  

 

____I will vote in office today.  _____I will take ballot/s with me.   ____Please mail ballot/s.

 ****************************************************************************************************** 

 

I, ___________________________, hereby request that an early ballot

 

be mailed to me for the ______________election occurring on _________.

                                                      (Primary, General, Special)                                               (Date)              

 

I am a registered voter residing at __________________________________

                                                                                                                (Address)

       ____________________                              _______________________________________________

           (Precinct)                                                                                     (Address)

      _____________________                             _______________________________________________

          (Political Party)                                                                        (City, State, Zip Code)

 

The ballot should be mailed to me at _______________________________

                                                                                                                (Address)

                                                                                 _____________________________________________

                                                                                                                (Address)

                                                                                 _____________________________________________

                                                                                                   (City, State, Zip Code)

____________________________________       

                    (Signature of voter)                                                        

 

____________________________________            _____________________________________

      (Signature of person acting as agent)                                (Relationship of agent to voter)

 

___________________________________                  

Office Use:

                          (Phone #)

Party:

 

Supr#:

___________________________________

S.D:

                             (Date)

NRD:

 

Ballot Type:

                                                                                                                                                                                 

If voting in the office, I the above signed voter, declare under penalty of election falsification, that the ballot or ballots contained no voting marks of any kind when I received them, and I caused the ballot or ballots to be marked, deposited by an election official into the sealed ballot box.   

**************************************************************************************

(The request for an early ballot to be mailed to a voter must be received by the Election Office no later than 4PM the Wednesday before an election.  The last day to vote early in the Election Office is the day before the election.  An agent can pick up a ballot for a voter up until 7PM election day)

 

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