ABSENTEE BALLOT APPLICATION

 

 

Absentee Ballot Application for: _________________________________________________

                                                                        (Print or type your name)

 ===================================================================

 

I hereby apply for absentee ballots for:

 

             (   )  Township Annual Election

 

I will need an absentee ballot for the following reason:

 

              (   )  absence form precinct

              (   )  illness or disability

              (   )  religious discipline or observance of religious holiday

              (   )  service as election judge in another precinct

 

 ===================================================================

 

   MY LEGAL RESIDENCE ADDRESS IS:

 

  ___________________________________________________________________________

          Street address

 

  ___________________________________________________________________________

          (  ) City                                             (  ) Township                                                   Zip     

      

 

   MAIL MY ABSENTEE BALLOT TO ME AT THE FOLLOWING ADDRESS:

 

   ___________________________________________________________________________

         Street address

 

  ____________________________________________________________________________

          City                                                                                   State                                     Zip

 

  __________________                                     _______________________________________           

          Date                                                                  Legal Signature

 

Send to Ten Lake Township Clerk:

Barbara D’Orazio

14664 Old Lodge Dr SE

Bemidji, MN 56601                                                                                                                             

Rev. 2-9-5