Form Gab 121 PDF Details

Voting is a cornerstone of democracy, enabling citizens to participate in shaping their government. The Wisconsin Application for Absentee Ballot, known as the GAB 121 form, plays a critical role in facilitating this right, especially for those unable to visit polling stations on Election Day. Tailored to ensure the inclusion of various voter groups, including military personnel, overseas citizens, and those confined due to health reasons, the form outlines specific procedures to obtain an absentee ballot. It mandates registrants to provide detailed personal information, choose their preferred method of ballot receipt—mail, fax, or email (with restrictions applicable to certain groups)—and specify the elections for which the absentee ballot is requested. Additionally, it caters to voters hospitalized at the time of elections, allowing them to designate an agent for ballot collection and submission. Completing and signing this form, thereby certifying the eligibility criteria as per Wisconsin law, is a crucial step for voters aiming to exercise their franchise. It is essential for applicants to carefully review the instructions and submit the GAB-121 form to their municipal clerk, ensuring their participation in the democratic process is unhindered.

QuestionAnswer
Form NameForm Gab 121
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesform gab app, wi absentee, ballot absentee wisconsin, how to wisconsin absentee

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Instructions

 

Wisconsin Application for Absentee Ballot

 

 

 

 

Confidential Elector ID#

 

SVRS ID #

 

(HINDI - sequential #) (Office Use Only)

 

(Office Use Only)

 

 

 

 

 

Instructions for completion are on the back of this form. Return this form to your municipal clerk when completed.

Please use uppercase (CAPITAL) letters only. Fill in circles as appropriate.

You must be registered to vote before you can receive an absentee ballot. You can confirm your voter registration at https://myvote.wi.gov

VOTER INFORMATION

1

 

 

O Town

 

 

 

 

 

 

 

 

Municipality

O Village

 

 

 

 

 

 

County

 

 

 

 

O City

 

 

 

 

 

 

 

 

 

Last Name

 

 

 

 

 

First Name

 

 

2

 

 

 

 

 

 

 

 

 

 

 

Middle Name

 

 

 

Suffix (e.g. Jr, II, etc.)

 

 

Date of Birth

 

 

 

 

 

 

 

(MM/DD/YYYY)

 

 

 

 

 

 

 

 

 

 

 

 

Phone

 

 

 

Fax

 

 

 

Email

 

 

 

 

 

 

 

 

 

 

 

 

 

3Residence Address: Street Number & Name

 

Apt. Number

 

City

 

State & ZIP

 

 

 

 

 

 

 

 

4

If you are a military or permanent overseas elector, fill in the appropriate circle (see instructions for definitions): Military PermanentOverseas

I PREFER TO RECEIVE MY ABSENTEE BALLOT BY: (Ballot will be mailed to the address above if no preference is indicated)

 

MAIL

Mailing Address: Street Number & Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VOTE IN

Apt. Number

 

 

City

 

 

State & ZIP

 

 

CLERK’S

 

 

 

 

 

 

 

 

 

Care Facility Name (if applicable)

 

 

 

 

5

OFFICE

 

 

 

 

 

 

 

 

C / O (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FAX

Fax Number

 

 

 

Military and Permanent Overseas only

 

EMAIL

Email Address

 

 

 

 

 

 

 

(required for email or

 

 

 

Military and Permanent Overseas only

 

 

online delivery)

 

 

 

I REQUEST AN ABSENTEE BALLOT BE SENT TO ME FOR: (mark only one)

 The election(s) on the following date(s): ____________________________________________________________________________

6 All elections from today’s date through the end of the current calendar year (ending 12/31).

 Every election subsequent to today’s date. I further certify that I am indefinitely confined because of age, illness, infirmity or disability and

request absentee ballots be sent to me until I am no longer confined or fail to return a ballot.

 

TEMPORARILYHOSPITALIZED VOTERS ONLY (please fill in circle)

 I certify that I cannot appear at the polling place on election day because I am hospitalized, and appoint the following person to serve as my agent, pursuant to Wis. Stat. § 6.86(3).

Agent Last Name

 

Agent First Name

 

Agent Middle Name

 

 

 

 

 

 

 

7AGENT: I certify that I am the duly appointed agent of the hospitalized absentee elector, that the absentee ballot to be received by me is received solely for the benefit of the above named hospitalized elector, and that such ballot will be promptly transmitted by me to that elector and then returned to the municipal clerk or the proper polling place.

 

Agent Signature

X

Agent Address

 

 

 

 

 

 

ASSISTANT DECLARATION / CERTIFICATION (if required)

I certify that the application is made on request and by authorization of the named elector, who is unable to sign the application due to physical disability.

Agent Signature

X

Today’s Date

VOTER DECLARATION / CERTIFICATION (required for all voters)

I certify that I am a qualified elector, a U.S. Citizen, at least 18 years old, having resided at the above residential address for at least 28 consecutive days immediately preceding this election, not currently serving a sentence including probation or parole for a felony conviction, and not otherwise disqualified from voting. Please sign below to acknowledge that you have read and understand the above.

Voter Signature

X

Today’s Date

GAB-121 | Rev 2013-11 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: gab@wi.gov

Wisconsin Application for Absentee Ballot Instructions

General Instructions: Please Review Fully This form should be submitted to your municipal clerk, unless directed otherwise.

This form should only be completed by registered voters; if you are not a registered voter or military elector, please submit a Voter Registration Application (GAB-131) with this form.

1 Indicate the municipality and county of residence. Use the municipality’s formal name (For example: City of Plymouth, Village of Chenequa, or Town of Aztalan).

Provide your name as you are registered to vote in Wisconsin. If applicable, please provide your suffix (Jr, Sr,

2

etc.) and/or middle name. If your current name is different than how you are registered to vote, please submit a Voter Registration Application (GAB-131) with this form to update your information.

 

Provide your month, day and year of birth. Remember to use your birth year, not the current year.

 

Providing your telephone/fax number or email address allows elections officials to contact you if there is a

 

problem with your absentee application.

 

 

 

3

Provide your home address (legal voting residence) in Wisconsin.

Provide the full house number (including fractions, if any).

 

 

Provide your full street name, including the type (St, Ave, etc.) and any pre– and/or post-directional (N, S, etc.).

 

Provide the city name and ZIP code as it would appear on mail delivered to the home address.

 

You may not enter a PO Box as a voting residence. A rural route box without a number should not be used.

 

 

 

4

A “Military elector” is a person, or the spouse or dependent of a person who is a member of a uniformed service

or the merchant marines, a civilian employee of the United States, a civilian officially attached to a uniformed

 

 

service and serving outside the United States, or a Peace Corp volunteer. Military electors do not need to

 

register to vote. Military electors will continue to receive ballots for all elections unless otherwise requested.

 

A “Permanent Overseas elector” is a person who is a United States citizen, 18 years old or older, who resided in

 

Wisconsin immediately prior to leaving the United States, who is now living outside the United States and has

 

no present intent to return, who is not registered in any other location, or who is an adult child of a United States

 

citizen who resided in this state prior to establishing residency abroad. Permanent Overseas electors will

 

receive ballots for federal offices only and must be registered to vote prior to receiving a ballot.

 

 

 

5

Fill in the circle to indicate your preferred method of receiving your absentee ballot. Only Military and

Permanent Overseas voters may receive an absentee ballot by email, fax, or online.

 

 

If you select “Online” you will receive an email instructing you how to access your ballot online.

 

Military and Permanent Overseas voters may request and access their ballot directly at https://myvote.wi.gov.

 

If no preference is indicated, your absentee ballot will be mailed to your residence address listed in Box 3.

 

You are encouraged to provide a physical mailing address as backup in case of electronic transmission

 

difficulties. Please only fill the circle for your preferred means of transmission.

 

If you are living in a care facility, please provide the name of the facility.

 

If someone will be receiving the ballot on your behalf, please list them after C/O. Please note: The absentee

 

elector is still required to vote their own ballot, although they may request assistance in physically marking the ballot.

6

Select the first option if you would like to receive a ballot for a single election or a specific set of elections.

Select the second option if you would like to have a standing absentee request for any and all elections that may

 

 

occur in a calendar year (ending December 31).

 

Select the third option only if you are indefinitely confined due to age, illness, infirmity or disability and wish to

 

request absentee ballots for all elections until you are no longer confined or fail to return a ballot for an election.

7

This section is only to be completed by an elector or the agent of an elector who is currently hospitalized.

A hospitalized elector must certify that he or she cannot appear at the polling place on Election Day.

 

 

An agent completing this form for a hospitalized elector must provide his/her name, signature and address on

 

this application.

Assistant Signature:

In the situation where the elector is unable to sign the Voter Declaration / Certification due to a physical

disability, the elector may authorize another elector to sign on his or her behalf. Any elector signing an

 

 

 

 

application on another elector's behalf shall attest to a statement that the application is made on request

 

 

and by authorization of the named elector, who is unable to sign the application due to physical disability.

Voter Signature:

By signing and dating this form, you certify that you are a qualified elector, a U.S. citizen, at least 18 years

old, having resided at your residential address for at least 28 consecutive days immediately preceding this

 

 

 

 

election, not currently serving a sentence including probation or parole for a felony conviction, and not

 

 

otherwise disqualified from voting.

GAB-121 | Rev 2013-11 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: gab@wi.gov

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