Gab-121 - Wisconsin Application For Absentee Ballot Page 2
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1
2Wisconsin Application for Absentee Ballot lnstructions
General
Instructions:
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
(EL-1
31) with this form.
Photo
lD
requirement:
lf you
will
receive your absentee ballot by mail,
and
have not
previously
provided a copy of acceptable photo
lD
with
a prior by-mail absentee
ballot
request, a copy
of
photo lD must accompany
this application.
You may submit your application
and a copy of
your
lD by mail, fax or
email.
ln-person voters must always show acceptable photo
lD.
The
following documents
are
acceptable Photo
lD (For specific information regarding expired documents
visit
)
State
of
Wl
driver license or lD
card
Certificate
of
Naturalization
Military
lD
card issued by a U.S. uniformed
service
Wl
DOT DL
or
lD
card
receipt
Photo lD issued by the federal Dept. of Veterans
Affarrs
CitationiNotice
to
revoke or suspend
Wl
DL
University. college or tech
college
lD and enrollment
verification
lD
card
issued by federally recognized
Wl
tribe
U.S.
passporl
booklet or card
ln lieu of photo
lD, the voters listed below may satisfy the
voter lD
requirement
by
the following means:
.
Electors
who
are indefinitely confined (see Section 6)
-
the signature of
a
witness
on the
Absentee
Certificate Envelope.
.
Electors residing
in
care facilities served by Special
Voting
Deputies
-
the signatures of both deputies on the envelope.
.
Electors residing
in
care facilities not served by Special
Voting
Deputies
-
the signature of an authorized representative
of
the
facility.
lf the elector
is
also
indefinitely confined, the elector
does
not need a representative of the facility to sign.
.
Military, Permanent Overseas and Confidential Electors
-
Exempt from the photo
lD
requirement.
1
.
lndicate the municrpality and county of
residence.
Use the municipality's formal name
(for
example: City
of
Ashland, Village of Greendale.
orTown ofAlbion),
2
.
Provide
your
name as
you
are registered to
vote
in
Wisconsin.
lf
applicable, please provide your suffix (Jr, Sr, etc.) and/or
middle
name.
lf your current name is different
than
how you
are
registered to vote, please submit
a
Voter
Registration
Application
(EL-1 31)
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.
3
.
Provide your home address (legal
voting
residence)
with
full house number (including
fractions,
if any).
.
Provideyourfull streetname,includingthetype(eg.,Ave.) andanypre-and/orpost-directional (N,S,etc.).
.
Provide the city name and
ZIP
code as
it
would appear on mail delivered to the home address.
.
You
mav not enter
a
PO Box as a
votinq residence. A
rural route box without a number
may
not be
used.
4
.
A"Militaryelector''
is a person,
orthe
spouse
ordependentof
a person
who
is a
memberof a
uniformed service
orthe
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.
.
A
"Permanent Overseas
electol'
is
a person
who
is a United States
citizen,
18
years old or older,
who
resided
in
Wisconsin
immediately
priorto
leaving
the
United States,
who
is
nowliving outsidethe
United States
and
has no present
intentto
return,
who
is not registered
in
any other location, or
who
is
an adult child of
a
United States
citrzen
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.
Onlv Militarv
and
Permanent Overseas
voters mav receive an absentee ballot bv
email
or
fax.
.
Military
and
Permanent Overseas voters may request and access
their
ballot directly at
o
lf
no preference is indicated, your absentee ballot
will
be mailed to
your
residence address listed in Box
3.
.
Youareencouragedtoprovideaphysical mailingaddressasbackupincaseofelectronictransmissiondifflculties.
Pleaseonly
fill the circle for your preferred means
of
transmrssion.
.
lf you are living
in
a care facility, please provide
the
name
of
the facility.
.
lf 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
assishnce
in physically marking
the
ballot.
b
.
Selectthefirstoptionifyouwouldliketoreceiveaballotforasingleelectionoraspecificsetofelections.
.
Select the second option if
you
would
like
to
have a standing
absentee
request for any and all elections
that
may
orcur
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
.
Thissectionisonlytobecompletedbyanelectorortheagentof
anelectorwhoiscurrentlyhospitalized.
.
An
agent completing
this
form for
a
hospitalized elector must provide his/her name, signature and address on
this
application.
Assistant Signature:
ln 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
anotherelector's
behalf shall
attestto
a
statementthatthe
application is made on request
and by authorization
of
the
named elector,
who
is unable to sign the application due to physical d,sability.
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
'10
consecutive
days
immediately preceding this
election,
not
cunently
serving a sentence including probation or parole for a felony conviction, and not
otheruurse
disqualified from voting.
EL-121
I Rev
2016-08
|
Wisconsin Elections Commiftee, P.O.
Box
7984, Madison,
W
53707-7984
|
6o&26ffi005
I
vveb:
eiections.V4{gv
I
email:
elections@wi.aov
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