"Application for absent voter ballot for:
[ ] The primary or special primary election to be held on ___________________ (Date).
[ ] The election to be held on _______ (Date).
(Check applicable election or elections)
I,.................................., a United States citizen and a qualified and registered elector of the............ precinct of the township of............ or of the............ ward of the city of .................................., in the county of .................................. and state of Michigan, apply for an official ballot, or ballots, to be voted by me at the election or elections as requested in this application.
Send absent voter ballot to me at: |
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........................................... |
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(Street No. or R.R. or Designated Address) |
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........................................... |
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(Post Office) |
(State) |
(Zip Code) |
My registered address ...................................... |
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(Street No. or R.R. or Participant Identification Number) |
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...................................... |
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(Post Office) |
(State) |
(Zip Code) |
Date........................................................ |
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I certify that I am a United States citizen and that |
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the statements in this absent voter ballot application |
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are true. |
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...................................... |
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(Signature) |
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WARNING |
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.
Certificate of Authorized Registered |
Elector Returning Absent Voter |
Ballot Application |
I certify that my name is...................., my address is...................., and my date of birth is............; that I am delivering the absent voter ballot application of.................... at his or her request; that I did not solicit or request to return the application; that I have not made any markings on the application; that I have not altered the application in any way; that I have not influenced the applicant; and that I am aware that a false statement in this certificate is a violation of Michigan election law.
_________________ |
_________________________________________ |
(Date) |
(Signature)" |
INSTRUCTIONS FOR APPLICANTS FOR ABSENT VOTER BALLOTS
Step 1. After completely filling out the application, sign and date the application in the place designated. Your signature must appear on the application or you may not receive an absent voter ballot.
Step 2. Deliver the application by 1 of the following methods:
MCL 168.759