REQUEST FOR EARLY VOTER ABSENTEE BALLOT
Name of early or absentee voter: _________________________________________
Voter's Town of Residence: _________________________________________
Current physical address (address where you reside):
_________________________________________
_________________________________________
Telephone Number: ___________
E-mail Address:
_______________________________________________________________________
Date: _________________________________________
I request early voter absentee ballot(s) for the election(s) checked below:
Please deliver the ballot(s) as indicated below (check one):
Street or P.O. Box
Town/City
State
Zip Code
If applicant is other than early or absentee voter:
Name of applicant: _________________________________________
Address of applicant: _________________________________________
Relationship to early or absentee voter: _________________________________________
Organization, if applicable: _________________________________________
Date: _________________________________________
Signature of applicant:
_________________________________________
17 V.S.A. § 2532