EARLY BALLOT REQUEST FORM 2018 - Platte …

1 EARLY BALLOT REQUEST form (formerly Absentee BALLOT ) Print this form , complete & SIGN the form . Then either mail, fax, email or deliver in person to: Diane M. Olmer, Platte County Election Commissioner Box 513 2610 14th Street Columbus, NE 68602-0513 Phone: 402 563-4908 Fax: 402 564-7733 Email: ____I will vote in office today. _____I will take BALLOT /s with me. ____Please mail BALLOT /s. ** I, _____, hereby REQUEST that an EARLY BALLOT be mailed to me for the _____election occurring on _____.

2 (Primary, General, Special) (Date) I am a registered voter residing at _____ (Address) _____ (Address) _____ (City, State, Zip Code) The BALLOT should be mailed to me at _____ (Address)

3 _____ (Address) _____ (City, State, Zip Code) _____ (Signature of voter) _____ _____ (Signature of person acting as agent) (Relationship of agent to voter) _____ Office Use: Precinct (Phone #) Party: Supr#: _____ : (Date) NRD: BALLOT Type: **For Nonpartisans ONLY: If you wish to vote in this primary election for Senator and/or House of Representative, you may REQUEST a partisan BALLOT as stated in 32 912 (2) from one of the political parties by checking the appropriate box.

4 (For the 2018 Primary, the Democratic Party opened its Primary Election to nonpartisans, so that BALLOT may contain federal, state and county offices. The Republican & Libertarian ballots, requested by nonpartisans, will contain only federal office candidates.) Democratic Libertarian Republican If voting in the office, I the above signed voter, declare under penalty of election falsification, that the BALLOT or ballots contained no voting marks of any kind when I received them, and I caused the BALLOT or ballots to be marked, deposited by an election official into the sealed BALLOT box.

5 ** (The REQUEST for an EARLY BALLOT to be mailed to a voter must be received by the Election Office no later than the close of business on the second Friday preceding the election. The last day to vote EARLY in the Election Office is the day before the election. An agent can pick up a BALLOT for a voter up until 7PM election day)