Print off and fill out the following application and mail to the Lincoln County Courthouse.

REQUEST FOR MISSOURI ABSENTEE BALLOT

I, __________________________________________, do hereby request an absentee

                            (print name)

ballot for the____________________________________________________ election:

For identification purposes, the last four digits of my social security number are: ______.

If the election is a primary election, please print the name of the political party ballot you wish to receive ____________________________________.

Reason for requesting an absentee ballot:

_____  (1) Absence on election day from the jurisdiction of the election authority in which registered to vote

_____  (2) Incapacity of confinement due to illness or physical disability, including a person who is primarily responsible for the physical care of a person who is incapacitated or confined due to illness or disability

_____  (3) Religious belief or practice

_____  (4) Employment as an election authority, as a member of an election authority, or by an election authority at a location other than your polling place

_____  (5) Incarceration, provided all qualifications for voting are retained

For the primary election if no selection is made, only ballot issues and non-partisan candidates (if applicable) will be included on the ballot mailed to you.

Address where I am registered to vote:

              ________________________________________     

                                          (Street Address)

                                          ________________________________________

                                          (City, State, Zip Code)

Address where ballot is to be mailed:

                                          ________________________________________

                                           (Street Address or Post Office Box Number)

                                          _________________________________________

                                          (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 Elaine Luck – County Clerk, Lincoln County Clerks Office, 201 Main St., Troy, MO 63379.

Missouri law requires that requests for absentee ballots must be received by 5:00 p.m. on the Wednesday prior to election day if the ballot is to be 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.

§§ 115.279, 115.284.5

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2008   Lincoln County Election Authority