Ala. Code § 17-11-7
"State of Alabama
County of ___________
I, the undersigned, do swear (or affirm) that:
My place of residence in Alabama is: | ________________ |
(street) | |
____________________ | Alabama __________ |
(city or town) | (zip code) |
My date of birth is: | __________ |
month day year |
I am entitled to vote an absentee ballot because:
Check at least one:
___ I expect to be out of the county or the state on election day.
___ I am physically incapacitated and will not be able to vote in person on election day.
___ I expect to work a required workplace shift which has at least 10 hours which coincide with the polling hours at my regular polling place.
___ I am a student at an educational institution located outside the county of my permanent residence and am therefore unable to vote at my usual polling place on election day.
___ I am a member of or a spouse or dependent of a member of the Armed Forces of the United States or am otherwise entitled to vote pursuant to the federal Uniformed and Overseas Citizens Absentee Voting Act, 42 U.S.C. 1973ff.
___ I have been appointed as an election officer at a polling place which is not my regular polling place.
___ I will be out of the county on election day responding to a state of emergency as declared by this state or any other state, or by the federal government.
___ I am a caregiver for a family member to the second degree of kinship by affinity or consanguinity and the family member is confined to his or her home.
___ I am currently incarcerated in prison or jail and I have not been convicted of a felony involving moral turpitude.
I further swear (or affirm) that I have not voted nor will I vote in person in the election to which this ballot pertains.
I have marked the enclosed absentee ballot voluntarily and I have read or had read to me and understand the instructions accompanying this ballot and I have carefully complied with such instructions.
Moreover, I further swear (or affirm) that all of the information given above is true and correct to the best of my knowledge and that I understand that by knowingly giving false information so as to vote illegally by absentee ballot that I shall be guilty of a misdemeanor which is punishable by a fine not to exceed one thousand dollars ($1,000) or confinement in the county jail for not more than six months, or both.
_________________ |
(Signature or mark of voter.) |
___________________ |
(Printed name of voter.) |
IF YOUR AFFIDAVIT IS NOT SIGNED (OR MARKED), AND IF YOUR AFFIDAVIT IS NOT WITNESSED BY TWO WITNESSES 18 YEARS OF AGE OR OLDER OR A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ACKNOWLEDGE OATHS, PRIOR TO BEING DELIVERED OR MAILED TO THE ABSENTEE ELECTION MANAGER, YOUR BALLOT WILL NOT BE COUNTED.
Sworn to and subscribed before me this _____ day of _____, 2__.
I certify that the affiant is known (or made known) to me to be the identical party he or she claims to be.
___________________ (Signature of official) |
(Title of official) |
___________________ |
(Address of official) |
OR |
1st Witness____________ | |
Signature | |
_____________ | |
Print name | |
_____________ | |
Address | |
______________ | |
City Zip Code |
2nd Witness______________ | |
Signature | |
_____________ | |
Print name | |
_____________ | |
Address | |
______________ | |
City Zip Code" |
Ala. Code § 17-11-7 (1975)