TO BE COMPLETED | |
BY THE CLERK | |
___________________________ | ___________________________ |
Name of Voter | Street Address or R.R. or Program Participant Identification Number |
___________________________ | ___________________________ |
City or Township | County |
Ward ______ Precinct ______ | Date of Election _____________ |
================================================================== | |
TO BE COMPLETED BY THE ABSENT VOTER |
I assert that I am a United States citizen and a registered elector of the city or township named above. I am voting as an absent voter in conformity with state election law. Unless otherwise indicated below, I personally marked the ballot enclosed in this envelope without exhibiting it to any other individual.
I further assert that this absent voter ballot is being returned to the clerk or an assistant of the clerk by me personally; by public postal service, express mail service, parcel post service, or other common carrier; by a member of my immediate family; or by an individual residing in my household.
DATE:______________ | SIGN HERE X_____________________________ |
Signature of Absent Voter | |
The above form must be signed or your vote may not be counted. | |
AN ABSENT VOTER WHO KNOWINGLY MAKES A FALSE STATEMENT IS GUILTY | |
OF A MISDEMEANOR. | |
================================================================== | |
TO BE COMPLETED ONLY IF VOTER IS ASSISTED IN VOTING | |
BY ANOTHER INDIVIDUAL |
I assisted the above named absent voter who is disabled or otherwise unable to mark the ballot in marking the absent voter's absent voter ballot pursuant to the absent voter's directions. The absent voter ballot was inserted in the return envelope without being exhibited to any other individual.
____________________ | ____________________ | ____________________ |
Signature of Individual | Street Address | City or Township |
Assisting Voter | or R.R. | |
________________________________________________________________ | ||
Printed Name of Individual Assisting Voter | ||
AN INDIVIDUAL WHO ASSISTS AN ABSENT VOTER AND WHO KNOWINGLY MAKES A FALSE STATEMENT IS GUILTY OF A FELONY. | ||
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WARNING |
INDIVIDUALS WHO CAN LEGALLY BE IN POSSESSION OF AN ABSENT VOTER BALLOT ISSUED TO AN ABSENT VOTER ARE LIMITED TO THE ABSENT VOTER; AN INDIVIDUAL WHO IS A MEMBER OF THE ABSENT VOTER'S IMMEDIATE FAMILY OR RESIDES IN THE ABSENT VOTER'S HOUSEHOLD AND WHO HAS BEEN ASKED BY THE ABSENT VOTER TO RETURN THE BALLOT; AN INDIVIDUAL WHOSE JOB IT IS TO HANDLE MAIL BEFORE, DURING, OR AFTER BEING TRANSPORTED BY A PUBLIC POSTAL SERVICE, EXPRESS MAIL SERVICE, PARCEL POST SERVICE, OR COMMON CARRIER, BUT ONLY DURING THE NORMAL COURSE OF THE INDIVIDUAL'S EMPLOYMENT; AND THE CLERK, ASSISTANTS OF THE CLERK, AND OTHER AUTHORIZED ELECTION OFFICIALS OF THE CITY OR TOWNSHIP. ANY OTHER INDIVIDUAL IN POSSESSION OF AN ABSENT VOTER BALLOT IS GUILTY OF A FELONY.
MCL 168.761