The Av1M form serves as a cornerstone in the democratic process for the residents of Kansas, facilitating their participation in elections through the medium of advance voting by mail. Prepared by the Office of the Kansas Secretary of State, this form embodies a commitment to ensuring every eligible voter can exercise their right to vote, even when they are unable to make it to the polls on Election Day. It outlines a clear, structured process for voters, starting with an affirmation of the voter's eligibility by county and state, followed by the critical voter identification requirements mandating a current and valid Kansas driver’s license or non-driver’s identification card number. For those without the specified Kansas IDs, alternative forms of identification are accepted, ensuring inclusivity. Personal information, including name, birthday, and addresses, both residential and where the ballot should be mailed, is meticulously collected to tailor the voting experience to each individual. Political party affiliation is only required when requesting a primary election ballot, respecting the voter's privacy and the confidentiality of their ballot. The form underscores the importance of accuracy and honesty, warning of the legal consequences of submitting false information, a testament to the integrity of the voting process. Designed with the voter's convenience and the sanctity of the election in mind, the Av1M form is a testament to Kansas’ dedication to upholding the democratic right to vote, ensuring no one is left behind.
| Question | Answer |
|---|---|
| Form Name | Form Av1M |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | KS, KSA, False, kansas form av1m |
Ofice of the Kansas Secretary of State
Application for Advance Ballot by Mail |
FORM |
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AV1M |
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DOWNLOAD THIS FORM AT WWW.SOS.KS.GOV |
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1. Afirmation |
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Afirmation of an Elector of the County of ____________________ and State of Kansas Desiring to Vote an Advance Voting Ballot
State of ____________________, County of ____________________, ss: (where application is completed)
2. Voter Identiication Requirements
I understand that my current and valid Kansas driver’s license number or Kansas nondriver’s indentiication card number must be provided in order to receive a ballot.
Current Kansas driver’s license number or nondriver’s identiication card number: ________________________________
If I do not have a current and valid Kansas driver’s license number or Kansas nondriver’s identiication card number, I must provide a copy of one of the following forms of identiication with this application in order to receive a ballot:
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Driver’s license issued by Kansas or another state |
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Employee badge or ID document issued by a government ofice |
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Nondriver’s ID card issued by Kansas or another state |
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U.S. military ID |
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U.S. passport |
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Student ID card issued by an accredited Kansas postsecondary |
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Concealed carry of handgun license issued by Kansas |
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educational institution |
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or another state |
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Public assistance ID card issued by a government ofice |
3. Personal Information Please print. |
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______________________________ |
______________________________ ____ |
__________________________ |
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Last Name |
First Name |
M.I. |
Date of Birth (MM/DD/YY) |
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__________________________________________ |
_______________________ |
__________ |
_____________ |
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Residential Address |
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City |
State |
Zip Code |
Political Party (To be illed in only when requesting a primary election ballot): □ Democratic □ Republican
4. Address to Mail Ballot (if different from residential address)
__________________________________________ |
_______________________ |
__________ |
_____________ |
Mailing Address |
City |
State |
Zip Code |
Note: The ballot may be mailed only to the voter’s residential or mailing address as indicated on the county voter registration list, to the voter’s temporary residential address, or to a medical care facility where the voter resides. These restrictions do not apply to a voter who has an illness, disability or who lacks proiciency in the English language. Ballots cannot be mailed until 20 days before the election.
5.Voter Signature Note: False statement on this afirmation is a severity level 9, nonperson felony.
I do solemnly afirm under penalty of perjury that I am a qualiied elector residing at the address listed above. I am entitled to vote an advance voting ballot and I have not voted and will not otherwise vote at the election to be held on
____________________ (date).
Required |
______________________________ |
______________________________ |
________________________ |
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Signature of Voter |
Date (MM/DD/YY) |
Phone Number |
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FOR OFFICE USE ONLY Date App. Rec’d. ____________ Ballot Mailed ____________ Transmitted by ____________
Prepared by the Ofice of Secretary of State Kris W. Kobach, 1st Floor, Memorial Hall, Topeka, KS
KSA