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Application Request

Voter Registration & Elections

Absentee Ballot Application Request

Instructions: ALL fields below are required except the voter registration number. If you do not know the information, you may write "unknown" or "n/a". If you are having trouble, please contact our office immediately.

I Would Like to Request an Absentee Application to be Mailed to Me For:
Your Full Name As Registered
Voter Registration Number
Residence Address
Residence City Zip
Mailing Address
Mailing City Zip
E-Mail
Day Phone Night Phone
If there is a runoff - would you like a ballot?
Yes No
Choose a reason for Voting Absentee Today
  1. A member of the Uniformed Services on Active Duty
  2. A member of the Merchant Marine
  3. A spouse of dependent of a member of the Uniformed Services or Merchant Marine
  4. A U.S. Citizen temporarily residing outside of the United States due to employment, serving with the American Red Cross, USO, Peace Corps, etc.
  5. A U.S. Citizen permanently residing outside of the United States
  6. Physical Disability
  7. Student, their spouse or dependents residing with them who are outside their county of residence
  8. For reasons of employment will not be able to vote on Election Day
  9. Government employee, their spouse or dependents residing with them, who are outside their county of residence on Election Day
  10. Person on vacation who will be outside their county of residence on Election Day
  11. Serving as a juror in a state or federal court on Election Day
  12. Admitted to the hospital as emergency patient on the day of the election or within a four-day period before the election
  13. Death or funeral in the family within a three-day period before the election
  14. Confined to a jail or pre-trial facility pending disposition of arrest or trial
  15. Attending a sick or physically disabled person
  16. Certified poll watcher, poll manager, county registration board or election commission member or staff working on Election Day
  17. Persons sixty-five years of age or older
Please complete the following to prevent automated entries.

Requester's Oath:

By clicking submit I do swear or affirm that I am a the person listed above, that I am a qualified elector, that I am entitled to vote in this election, and that I will not vote again during this election. The information above is true in all aspects, and I herby request an application for an absentee ballot be sent to me. Any person who fraudulently applies for an absentee ballot in violation of this section, upon conviction, must be punished in accordance with Section 7-25-20.