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Absentee Ballot
I formally
“Request an Absentee Ballot” based upon the
following information.
1) PRINT NAME
__________________________________________________
2) ADDRESS ON
VOTER REGISTRATION
__________________________________________________
3) MAIL MY ABSENTEE
BALLOT TO THIS ADDRESS
_________________________________________________
4) MY SOCIAL SECURITY # IS
_________________________________________________
5) DATE OF BIRTH ___________________
6) MY LEGAL REASON FOR VOTING ABSENTEE
(Check One)
____ 65 years of age or older.
____ College Student
____ Outside of this county during all hours
of early voting and Election Day.
____ Filed a Doctor’s Statement stating I am
medically unable to vote in person.
____ I am a member of the military, or I am
a family member to the member of the
military.
____ I reside in a licensed facility
providing relatively permanent domiciliary
care (Nursing Home).
____ Hospitalized, ill or physically
disabled or I am a caretaker of a person who
is.
____ Candidate for office in the Election
____ Serving as an Election Official
____ I am an overseas citizen.
____ Serving on jury duty in a state or
federal court.
____ I have a Commercial Drivers License &
will be out of county (early voting &
Election Day).
Commercial License # ____________________
____ Observing a religious holiday that
prevents me from voting early or on Election
Day.
____ Other:
_____________________________________________________________
7) SIGNATURE OF VOTER
__________________________________________________
8) POLITICAL PREFERENCE: Democrat or
Republican
Mail to: Henry County Election Commission
▪
PO Box 967
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Paris TN 38242
Or Fax the Completed Form to: (731) 644-7302 |
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