APPLICATION FOR BALLOT BY MAIL

PLEASE PRINT

1.  Name:                                                                                                                                

 

2.  Residence Address as registered to vote.                                                                            

      Street address, apt #, city, state, zip

                                                                                                                                               

 

3.  Mail my ballot to (if different from above)                                                                            

 

                                                                                                                                               

 

County Election Precinct Number                                                                       

 

Voter Registration Number                                                                                   

 

Type & Date of Election                                                                                   

 

__________   Check here if you wish to receive ballots for both the main election and runoff elections, if applicable.

 

Party Preference (Primary Election Only)                                                                                                               

 

Telephone number (optional)                                                                                                                               

YOU MUST CHECK THE REASON YOU ARE APPLYING FOR AN EARLY BALLOT.

 

1.           65 years of age or older.                          

 

2.           Confinement in jail.

 

3.           Disability.        

 

4.           Expected absence from county on election day and during clerk’s regular office

hours for the remainder of the early voting period.  Application must be submitted from outside county if submitted after early voting in person has begun.  YOUR BALLOT MUST BE MAILED TO AN ADDRESS OUTSIDE THE COUNTY.

 

If 4 is checked, give date you can receive mail at the address given                                       

I certify that the information given in this application is true and I understand that giving false information in this application is a crime.

 

 

                                                                                                                                               

Signature of applicant

INSTRUCTIONS FOR APPLICATION FOR BALLOT BY MAIL

DEADLINE – Your application must be received by the early voting clerk not earlier than the 60^th day and not later than the 7^th day before election day.  If the 7^th day is a weekend or holiday, the deadline is the first preceding business day.

Application can be faxed from outside the county to 806-468-5509.

Mail completed application to :  Early Voting Clerk, P.O. Box 660, Canyon TX 79015