Absentee Ballot Application

REQUEST FOR MISSOURI ABSENTEE BALLOT

I, , do hereby request an absentee ballot for the
Printed name

Election.
Election Date

For identification purposes, the last four digits of my social security number are: .
If this is a primary election, please print the name of the political party ballot you wish to receive: .

Reason for requesting an absentee ballot:

Absence on Election Day from the jurisdiction of the election authority in which I am registered;

Incapacity or confinement due to illness or physical disability on election day, including caring for a person who is
incapacitated or confined due to illness or disability and resides at the same address;

Religious belief or practice

Employment as an election authority or by an election authority at a location other than my polling place, a first
responder, a health care worker, or a member of law enforcement;

Incarceration, although I have retained all the necessary qualifications for voting;

Certified participation in the address confidentiality program established under sections 589.660 to 589.681
because of safety concerns.

Address where I am registered to vote:

(Street Address) APPLICATION MUST BE
RECEIVED BY
(City, State, Zip Code) ELECTION AUTHORITY
NO LATER THAN
Address where ballot is to be mailed: 3/26/2025

(Street Address or PO Box)

(City, State, Zip Code)

Telephone number:
(Include Area Code)

I do solemnly swear that all statements made on this application are true to the best of my knowledge and belief.

Signature of Registered Voter Date

Mail this completed form to your local election authority - Taney County Clerk, PO BOX 156, Forsyth, Mo. 65653. Missouri law
requires that requests for absentee ballots must be received by 5:00 p.m. on the second Wednesday prior to Election Day if the
ballot is mailed. The deadline for absentee voting in person in the office of the election authority is 5:00 p.m. on the day before
the election. If you registered by mail and this is your first time voting, you must provide a copy of either: (1) a nonexpired Missouri
driver’s or nondriver’s license; (2) a nonexpired military ID, including a veteran’s ID card; (3) a nonexpired United States passport; or
(4) another photo ID issued by the United States or the state of Missouri which is either not expired or expired after the date of the
most recent general (November) election.

§§ 115.279, 115.283, 115.284, 115.427 (8/2022)
PL 107-252