APPLICATION OF ABSENTEE VOTER’S BALLOT

 

Complete and mail this form to:

Brady Township Clerk’s Office,

P.O. Box 20, Vicksburg, MI 49097

 

or FAX it to ATTN: Township Clerk (269)649-4309

 

As a duly qualified and registered elector in the TOWNSHIP OF BRADY, County of KALAMAZOO and State of Michigan, I hereby make application for an official Absent Voter’s Ballot for the General Election, November 4, 2008.

 

NAME as registered (please print) _____________________________________________________

 

STREET ADDRESS of registration ______________________________________ZIP____________

 

NOTE: Michigan law requires that an Absentee Voter’s Ballot be sent to your registered address unless you are hospitalized, institutionalized, or at an address outside of your community.

 

Complete this section ONLY if you want your ballot sent to an address outside of your

community or to a hospital or other institution:


Send AV Ballot to me at: Street Address ________________________________________________

 

City _____________________________________State___________________Zip______________

 

CHECK REASON FOR REQUESTING AN ABSENTEE VOTER’S BALLOT.

IF A REASON IS NOT CHECKED AN ABSENTEE BALLOT CANNOT BE ISSUED.

 

_______ I am 60 years of age or older.

 

_______ I expect to be absent from the Community in which I am registered for the entire time

                 the polls are open on Election Day.

 

_______ I am physically unable to attend the polls without the assistance of another.

 

_______ I cannot attend the polls because of the tenets of my religion.

 

_______ I have been appointed an election inspector in a precinct other than the precinct where I reside.

 

_______ I cannot attend the polls because I am confined to jail awaiting arraignment or trial.


WARNING: A PERSON WHO MAKES A FALSE STATEMENT IN THIS DECLARATION IS

GUILTY OF A MISDEMEANOR.

 

It is a violation of the Michigan election law for a person other than those listed in the instructions to return, offer to return, or solicit to return your Absent Voter Ballot application to the Clerk.

 

SIGN HERE “X” ______________________________________________________________


Birth Date ________________________ Today’s Date _________________________________

 

CLERK’S RECORD (FOR CLERK’S USE ONLY)

 

Precinct ____________________________________ Ballot No. _________________________


Ballot Mailed _____/____/____ Ballot Returned _____/_____/____ Clerk __________________


 

 

 

 

 

 

 

 

 

Instructions for Application for Absent Voter’s Ballot


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 will not receive an absent voter ballot.

 

Step 2. Deliver the application by one of the following methods:

 

A. Place the application in an envelope addressed to the appropriate clerk and place the necessary postage upon the return envelope and deposit it in the United States mail or with another public postal service, express mail service, parcel post service, or common carrier.

 

B. Deliver the application personally to the office of the Clerk, to the Clerk, or to an authorized assistant of the Clerk to your appropriate Township or City.


C. In either (A) or (B), a member of the immediate family of the voter, including father-in-law, mother-in-law, brother-in-law, sister-in-law, grandparent, grandchild, or residing in the voter’s household may mail or deliver the application to the clerk for the applicant.

 

CERTIFICATE OF AUTHORIZED REGISTERED ELECTOR RETURNING ABSENT VOTER BALLOT APPLICATION


FILL THIS BOTTOM PORTION ONLY IF YOU ARE ASSISTING A VOTER



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; I am aware that a false statement in this certificate is a violation of Michigan election law.


X _____________________________________________ ________________

Signature                                                                                       Date


WARNING: A person making a false statement in this absent ballot application is guilty of a misdemeanor. It is a violation of Michigan election law for a person other than those listed in the above instructions to return, offer to return, agree to return or solicit return your absent voter ballot to the clerk. An assistant authorized by the clerk who receives the voter ballot applications at a location other than the office of the clerk 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.