Absentee Ballot Note Form PDF Details

Did you know that in order to vote by absentee ballot, you must complete a form? The Absentee Ballot Note Form is used to request an absentee ballot and ensure that your vote is counted. This form must be completed and returned to your local board of elections before the deadline in order to receive your absentee ballot. Be sure to read the instructions carefully so that you can submit the right information. Voting by absentee ballot is a great way to make sure your voice is heard, even if you can't make it to the polls on election day.

QuestionAnswer
Form NameAbsentee Ballot Note Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesluzerne county mail in ballot, luzerne county absentee ballot, absentee ballot for luzerne county pa, luzerne county absentee ballot application

Form Preview Example

MAIL TO:

 

LUZERNE COUNTY BUREAU OF ELECTIONS

INSERT PHONE NUMBER HERE: ____________________

20 N PENNSYLVANIA STE 207

 

WILKES BARRE PA 18701

 

APPLICATION FOR ABSENTEE BALLOT

NOTE: A separate absentee ballot application must be submitted to your county board of elections for each primary or election.

(PLEASE PRINT NAME EXACTLY AS REGISTERED)

(HOME ADDRESS)

 

 

 

(POST OFFICE)

(ZIP CODE)

(COUNTY)

 

 

 

 

 

 

 

 

 

 

 

 

(MUNICIPALITY)

(WARD)

(DISTRICT)

 

 

 

 

 

 

 

 

 

 

 

 

(OCCUPATION)

 

 

 

 

(DATE OF BIRTH)

I have lived at this address since_________________________________

State or Federal Government employees check here (

).

 

 

 

 

 

 

 

 

 

 

 

 

 

MAIL BALLOT TO ME AT THE FOLLOWING ADDRESS

 

 

 

 

 

 

 

 

 

 

 

(STREET ADDRESS)

 

 

 

 

 

 

 

 

 

 

 

 

 

(POST OFFICE)

(STATE)

(ZIP CODE)

 

 

 

 

 

 

I HEREBY APPLY FOR AN ABSENTEE BALLOT FOR THE FOLLOWING REASON:

 

□

 

ABSENCE FROM THE MUNICIPALITY

 

□

 

 

ILLNESS OR PHYSICAL DISABILITY

 

 

 

 

 

 

 

COMPLETE SECTION A

 

 

 

 

COMPLETE SECTION B

SECTION A – ABSENCE FROM THE MUNICIPALITY

 

 

 

 

 

I declare that I am eligible to vote absentee at the forthcoming primary or election since I expect that my duties, occupation or business will require me to be absent from the municipality of my residence on the day of the primary or election for the reason stated below; and that all of the information which I have listed on this absentee ballot application is true and correct.

 

(INSERT REASON FOR ABSENCE HERE)

(DATE)

(SIGNATURE OF ELECTOR)

SECTION B – ILLNESS OR PHYSICAL DISABILITY

I declare that I am eligible to vote absentee at the forthcoming primary or election due to the illness or physical disability stated below; that the information required to be listed pertaining to my attending physician is correctly stated herein and that all other information that I have listed on this absentee ballot application is true and correct.

(INSERT PHYSICAL ILLNESS OR DISABILITY HERE)

(NAME OF PHYSICIAN)

(PHONE NO.)

 

 

 

(OFFICE ADDRESS)

 

 

(DATE)

(SIGNATURE OF ELECTOR)

IF UNABLE TO SIGN COMPLETE SECTION C

SECTION C

The following to be completed if applicant is unable to sign because of illness or physical disability. I hereby state that I am unable to sign my application for an absentee ballot without assistance because I am unable to write by reason of my illness or physical disability. I have made, or have received assistance in making my mark in lieu of my signature.

(DATE)

(MARK)

 

 

(COMPLETE ADDRESS OF WITNESS)

(SIGNATURE OF WITNESS)

NOTE: Electors requiring assistance in voting must procure Special Form from the county Board of Elections to transmit with this application.

WARNING – IF YOU ARE ABLE TO VOTE IN PERSON ON ELECTION DAY, YOU MUST GO TO YOUR POLLING PLACE, VOID YOUR ABSENTEE BALLOT AND VOTE THERE.

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This form needs some specific information; in order to guarantee correctness, make sure you take note of the next steps:

1. Begin filling out your luzerne county pa absentee ballot application with a number of essential blanks. Get all of the necessary information and ensure there's nothing left out!

How to fill out luzerne county absentee ballot stage 1

2. Your next step would be to fill in these blank fields: STREET ADDRESS, POST OFFICE STATE ZIP CODE, I HEREBY APPLY FOR AN ABSENTEE, ABSENCE FROM THE MUNICIPALITY , COMPLETE SECTION A COMPLETE, INSERT REASON FOR ABSENCE HERE, DATE SIGNATURE OF ELECTOR, SECTION B ILLNESS OR PHYSICAL, and INSERT PHYSICAL ILLNESS OR.

Step number 2 for filling out luzerne county absentee ballot

Be really attentive when filling in INSERT PHYSICAL ILLNESS OR and SECTION B ILLNESS OR PHYSICAL, because this is where a lot of people make errors.

3. This third part will be hassle-free - complete all the empty fields in NAME OF PHYSICIAN PHONE NO, OFFICE ADDRESS, DATE SIGNATURE OF ELECTOR, IF UNABLE TO SIGN COMPLETE SECTION, SECTION C The following to be, DATE MARK, COMPLETE ADDRESS OF WITNESS, and NOTE Electors requiring assistance to conclude this process.

Completing segment 3 in luzerne county absentee ballot

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