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2024 RV Application

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Kaden Mays
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15 views

2024 RV Application

Uploaded by

Kaden Mays
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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ARKANSAS APPLICATION FOR ABSENTEE BALLOT

Revised 08/2023
TO: Becky Lewallen 07/23/2024
Date: ________________
Washington County Clerk Phone: 479-444-1711
280 North College Ave, Ste. 300 Email: [email protected]
Fayetteville, AR 72701 Fax: 479-444-1894

Information and Tips for Completing the Absentee Ballot Application

x Complete both pages of the application.


x Complete all fields, then sign and date the application. Failure to do so will result in delays in receiving your absentee ballot.
x Read all notes and acknowledgments included on the application.
x Double check all selections and information provided before submitting your application.
x If applicable, ensure the designated bearer, administrator, or authorized agent has signed the application in Section 5.
x UOCAVA: The Uniformed and Overseas Citizen Absentee Voting Act. UOCAVA voters are U.S. citizens who are active duty
military personnel, their eligible family members, and overseas citizens away from their normal polling location.
x Return your application to your county clerk via mail, fax, email, or hand delivery.
x If you have questions on how to complete this application, please contact your local county clerk’s office.

Kaden Mays
PRINT NAME: _________________________________________

COMPLETE ALL 6 SECTIONS OF THE APPLICATION

SECTION 1: PLEASE SELECT A REASON FOR REQUESTING AN ABSENTEE BALLOT:


I will be unavoidably absent from my polling site on Election Day, OR
I will be unable to attend the polls on Election Day because of an illness or physical disability, OR
I am a resident of a long-term care or residential facility licensed by the state, OR
I will be unable to attend the polls on Election Day due to an observance of a religious discipline or religious holiday.

SECTION 2: PLEASE SELECT FROM THE FOLLOWING OPTIONS CONCERNING YOUR RESIDENCE:
I currently reside within the county in which I am registered to vote.
I currently reside outside of the county in which I am registered to vote.
I am a United States citizen residing outside of the territorial limits of the United States (UOCAVA).
I am an active service member of the United States armed services residing outside of the county (UOCAVA).
I am a spouse or dependent of an active service member of the United States armed services (UOCAVA).

You may qualify for:


All elections for one calendar year (i.e., today’s date through December 31st of the current year).
x In order to qualify for this option, you must be a voter with a disability, in a long-term or residential care facility, or living
outside of the county in which you are registered to vote.
All elections through the next Federal General Election Cycle.
x In order to qualify for this option, you must be a UOCAVA voter (See Section 2 on front page).

FOR THE PREFERENTIAL PRIMARY (MARCH 5, 2024) YOU MUST SELECT A PARTY PREFERENCE IN SECTION 3

SECTION 3: PLEASE SELECT THE ELECTION IN WHICH YOU WISH TO CAST AN ABSENTEE BALLOT:
Preferential Primary/Nonpartisan Judicial General: March 5, 2024
Party Preference (Check Only One):
Democratic (Ballot will contain democratic, nonpartisan judicial annual school and any special elections.)
Republican (Ballot will contain republican, nonpartisan judicial, annual school and any special elections.)
Nonpartisan (You will be sent a ballot that contains only nonpartisan judicial races, annual school and special
elections).
November General Election/Nonpartisan Judicial Runoff: November 5, 2024
General Run Off: December 3, 2024: If you did not vote in the General Election on November 5, 2024
Special Election held on___________________________

Please Continue to Page 2


SECTION 4: PLEASE SELECT HOW YOU WISH TO RECEIVE YOUR BALLOT: FOR OFFICE USE ONLY

I will pick up my ballot from the office of the county clerk. DATE:
Email (Only available for UOCAVA voters).
Email address:
Mail. Please send my ballot to the following address: REGISTRANT ID:

722 Commonwealth Avenue, Boston, Massachusetts,


PRECINCT:
02215

Picked up via Designated Bearer, Administrator, or Authorized

Printed Name of Bearer/Administrator/Agent Signature of Bearer/Administrator/Agent

Note: A designated bearer may obtain or deliver absentee ballots for no more than two (2) voters per election and may only do so
within the 15 days before a school election, special election, preferential primary election, or general election OR the 7 days before
a runoff election. A bearer, administrator, or authorized agent must provide a current and valid photo ID to the county clerk and
must sign the register, under oath, when picking up or delivering an absentee ballot.

SECTION 5: PLEASE INDICATE WHETHER OR NOT YOU RECIEVED ASSISTANCE IN COMPLETING THIS APPLICATION:

I, the applicant, filled out this Application for Absentee Ballot on my own with no assistance.
I, the applicant, received assistance in filling out this Application for Absentee Ballot.

If YES, the person giving assistance must complete the information below:

Printed Name of Person Giving Assistance Signature of Person Giving Assistance

Residential Address of Person Giving Assistance

SECTION 6: PLEASE COMPLETE ALL INFORMATION BELOW AND SIGN THE APPLICATION:

The information I have provided is true to the best of my knowledge under penalty of perjury. If I have provided false information, I may be guilty of
perjury and subject to a fine of up to ten thousand dollars ($10,000) or imprisonment for up to ten (10) years, or both, under federal law. I certify under
penalty of perjury that I am registered to vote, and that I am the person who is registered to vote.

Kaden Mays 07/27/2003


Printed Name of Absentee Voter Date of Birth of Absentee Voter

4005 N Old Wire Road


Residential Address of Absentee Voter Signature of Absentee Voter

Fayetteville, AR, 72703 (479) 657-5519


City, State, and Zip Code Phone Number of Absentee Voter

[email protected]
Email Address of Absentee Voter

You may return this application to the County Clerk, via mail, fax, email or hand delivery.

Email Address: [email protected]

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