"Michigan Absent Voter Ballot Application - Large Print" - Michigan

Michigan Absent Voter Ballot Application - Large Print is a legal document that was released by the Michigan Secretary of State - a government authority operating within Michigan.

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Michigan Absent Voter Ballot Application – Large Print
I certify that I am a United States citizen and a qualified and
registered elector of the Michigan city or township listed above,
and I apply for an official ballot, to be voted by me in the
election(s) checked above, and the statements in this application
are true.
Voter’s Registration Information:
City
1
Township
Complete
First Name
M.I.
Last Name Jurisdiction
I want to vote
absentee in all future
elections.
Street Address
May 4, 2021
City
Zip Year of Birth (Optional)
)
(
Email Address*
Phone #*
Voter’s Signature (Power of attorney is not acceptable):
I certify that I am a United States citizen and that the
statements in this absent voter ballot application are true.
2
Sign
X
/ /
Signature
Date
Michigan Absent Voter Ballot Application – Large Print
I certify that I am a United States citizen and a qualified and
registered elector of the Michigan city or township listed above,
and I apply for an official ballot, to be voted by me in the
election(s) checked above, and the statements in this application
are true.
Voter’s Registration Information:
City
1
Township
Complete
First Name
M.I.
Last Name Jurisdiction
I want to vote
absentee in all future
elections.
Street Address
May 4, 2021
City
Zip Year of Birth (Optional)
)
(
Email Address*
Phone #*
Voter’s Signature (Power of attorney is not acceptable):
I certify that I am a United States citizen and that the
statements in this absent voter ballot application are true.
2
Sign
X
/ /
Signature
Date
WARNING:You must be a United States citizen to vote.
If you are not a United States citizen, you will not be
issued an absent voter ballot. A person making a false
statement in this absent voter ballot application is guilty
of a misdemeanor. It is a violation of Michigan election
law for a person other than those listed in the instructions
to return, offer to return, agree to return, or solicit to
return your absent voter ballot application to the clerk. An
assistant authorized by the clerk who receives absent
voter ballot applications at a location other than the
clerk’s office must have credentials signed by the clerk.
Ask to see his or her credentials before entrusting your
application with a person claiming to have the clerk’s
authorization to return your application.3a. Address to
Mail Ballot [Only fill out 3b. Future Elections: if different
from above]:
USPS will not forward your ballot. We c c an an m m ai ail l i i t to
t to y y ou
ou
USPS will not forward your ballot. We
3
where you are.
Other
State
Zip
D D at ate e
D D at ate e
returning
l l eav
eavi i ng ng
Street Address
from this
for for t t h h is is
address
addr
addres ess s : :
/ /
/ /
/ / /
Ci City ty
State
Zip
4
Return this application to your city/township clerk.
Return
Find your clerk at mi.gov/vote.
* Your e-mail address and phone number will be used only for
official election purposes.
Certificate of Authorized Registered Elector
Returning Absent Voter Ballot Application:
I certify that my name is
Complete
_______________________________________, date
only if
of birth is ____/____/____ and my address is
assisting a
_____________________________________
voter with
_______________________________________; that I
return of
am delivering the absent voter ballot application of
the
_________________________ at his or her request;
application
that I did not solicit or request to return the application;
that I have not made any markings on the application;
that I have not altered the application in any way; that I
have not influenced the applicant; and that I am aware
that a false statement in this certificate is a violation of
Michigan election law.
X________________________ ____/____/____
Signature of person assisting the voter Date
Clerk’s Use Only
Primary
General
Wd/Pct
Mailed
/
/
Returned
/
/
Mailed
/
/
Returned
/
/
Filed
/
/
Ballot No:
Clerk
Ballot No:
Clerk
Instructions for Absent Voter Ballot Applicants
Step 1: Fill out the application completely. You must
sign the form to get a ballot.
Step 2: Deliver the application in any of these ways:
1. Mail it. Make sure the envelope has proper
postage and is addressed to your local clerk.
2. E-mail it. Take a picture of the form (or
scan it) and e-mail it to your clerk. Make sure
your signature is visible.
3. Deliver it in person to the clerk, the clerk’s
office, or the clerk’s authorized assistant.
Someone in your immediate family or living in your
household can help you deliver this application. If
that’s not possible, you can ask any Michigan
registered voter to deliver it for you. The person
helping you must sign the “Certificate of Authorized
Registered Elector Assisting in Returning Application”.
Contact your local clerk
You can find your local clerk’s address, e-mail
address, and phone number by going to
Michigan.gov/Vote
and clicking on “your clerk”
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