Absentee Voting
THERE IS NO ABSENTEE VOTING AVAILABLE FOR ANY ELECTION AT THIS TIME
If you have questions or need more help, please contact our office
615-444-0216
PRINT NAME _________________________________________________________________________
2) ADDRESS ON VOTER REGISTRATION __________________________________________________ 3) BALLOT TO THIS ADDRESS ____________________________________ 4) MY SOCIAL SECURITY # IS _________________________________________________ 5) MY DATE OF BIRTH IS ___________________________________________________ 6) Election Rep ________ Dem _________ (Check One)
If voter is unable to sign their name, or receives assistance with this form, the person assisting and one witness must also sign their name and address. 1.____________________________________________________________________________ Name and address of person assisting 2.____________________________________________________________________________ Name and address of person witnessing FORWARD THIS INFORMATION TO: WILSON COUNTY ELECTION COMMISSION Completed form must be received by 203 East Main St. or P.O. BOX 97 July 26, 2012 LEBANON, TN 37088 FOR WILSON COUNTY ELECTION OFFICE USE: (Circle One) This Request has been: Approved - Rejected on ___________ by _______________ Voting Precinct/District _____________ Application Signature verified on ________by____________ Ballot Sent _______ Ballot Rcvd ________ Ballot Affidavit Signature verified on_______by________ BALLOT INFORMATION: PHONE # 615-444-0216 FAX # 615-443-2669 ============================================================================ ____ I am over 65 years of age. ____ I will be outside of this county during all hours of early voting and Election Day (must include mailing address outside county to mail absentee ballot.) ____ I am enrolled as a full-time student (or I am the spouse of a student) at an institution inside Tennessee and outside the county where I am registered. ____ I am a voter with a disability and my polling place is inaccessible. ____ I am a member of the military, or I am a family member to the member of the military. Ballot to be sent: By-Mail Electronically: E-mail address: _______________________ ____ I reside in a licensed facility, outside the county, providing relatively permanent domiciliary care (Nursing Home). ____ I am hospitalized, ill or physically disabled or I am a caretaker of a person who is. ____ I am a candidate. ____ I am an election official. ____ I am an overseas citizen. ____ I am on jury duty in a state or federal court. ____ I am observing a religious holiday that prevents me from voting early or on Election Day. ____ I have a Commercial Drivers License & will be out of county (early voting & Election Day). 7) ***My CDL # is ___________________________________ 8) SIGNATURE OF VOTER ___________________________________________________
I formally "Request an Absentee Ballot" based upon the following information.
1)
