Transcription of Nebraska Early Voting
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Nebraska Early Voting
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 supervisio
§32-941 Updated December 2017 Nebraska Early Voting Ballot Application Date: _____ I, the undersigned, declare that I am a registered voter in Nebraska.
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