Transcription of County Election Office Ballot Application
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County Election Office Ballot Application
32-941 Updated August 2018 Nebraska early voting Ballot Application Date: _____ I, the undersigned, declare that I am a registered voter in Nebraska. I am registered at the following address: _____, in _____ County . I am requesting early voting ballots for the following Election : Primary General Special (*The first day to request an early voting Ballot is 120 days before an Election ) to be held on _____ _____, 20_____. I request to vote in the Election Office today as the early voting Polling Place. I request that ballots be mailed to me, (or to the person I am acting as agent for), at the following address: Address Line 1: _____ Address Line 2: _____ City, State, Zip: _____ I request to take the ballots with me, (or to the person I am acting as agent for, up to two people). To confirm any information prior to sending the ballots, the Election Office may reach me at: Phone: _____ Email: _____ Voter s Printed Name: _____ Voter s Signature: _____ Voter s Date of Birth (MM/DD/YYYY) ____ /____ /_____ If applying for another voter: Agent s Signature: _____ Relationship: _____ Election falsification is a Class IV felony and may be punished by up to two years imprisonment and twelve months post-release superv
§32-941 Updated August 2018 . Return completed application to: Nebraska Early Voting . Ballot Application . Date: _____ I, the undersigned, declare that I am a registered voter in Nebraska.
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