Fillable Gab-121 - Wisconsin Application For Absentee Ballot (Page 2 of 2) in pdf

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.



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,

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.



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.



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



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.



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 nursing home, 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.



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.



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.

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

Assistant Signature:

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.

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

Voter Signature:

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

Gab-121 - Wisconsin Application For Absentee Ballot Page 2

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