Absentee Ballot

CIVILIAN ABSENTEE BALLOT APPLICATION
You must apply for an Absentee Ballot for each Election.

I hereby apply for an absentee ballot for the (check one)
Primary General Municipal Special
School.... Local Regional Voc. Tech.

Other_____________________________
SPECIFY
To be held on____________________
DATE

CHECK AND COMPLETE
I live in the City Town Township Borough Village

of:________________________________________________________

My legal residence address including Street Number and/or R.D. Number and Box Number is as follows:
Street address______________________________________________________________

Municipality__________________________Zip Code___________Phone________________

Mail my ballot to the following address:

Street address______________________________________________________________

Municipality______________________________ State___________Zip Code____________

CHECK REASON FOR BALLOT
I am unable to vote at my regular polling place on election day because:

I expect to be absent from the State of New Jersey on election day.

My date of departure is:________________________________

Of illness or physical disability including blindness or pregnancy.

I am permanently and totally disabled.

State reason:___________________________________________________
*

I am permanently and totally disabled and wish to receive an absentee ballot for

all elections to be held during the remainder of the calendar year.

Observance of a religious holiday on election day.

Resident attendance at a school, college or University on election day.

Of nature and hours of my employment on election day.

Under penalty of Law, I certify that the foregoing statements made by me are true and correct.

SIGN YOUR NAME AS IT APPEARS IN REGISTRY BOOK

PRINT OR TYPE YOUR NAME AS IT APPEARS IN THE REGISTRY BOOK

Print this page for your Absentee Ballot Application then
Mail the completed Absentee Ballot Application to: