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

Wisconsin Application for Absentee Ballot Instructions

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-131) with this form.

Photo ID requirement: If you will receive your absentee ballot by mail, and have not previously provided a copy of acceptable photo

ID with a prior by-mail absentee ballot request, a copy of photo ID must accompany this application. You may submit your application

and a copy of your ID by mail, fax or email. In-person voters must always show acceptable photo ID.

The following documents are acceptable Photo ID (For specific information regarding expired documents visit )

State of WI driver license or ID card

Certificate of Naturalization

Military ID card issued by a U.S. uniformed service

WI DOT DL or ID card receipt

Photo ID issued by the federal Dept. of Veterans Affairs

Citation/Notice to revoke or suspend WI DL

University, college or tech college ID and enrollment verification

ID card issued by federally recognized WI tribe

U.S. passport booklet or card

In lieu of photo ID, the voters listed below may satisfy the voter ID 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. If 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 ID requirement.



Indicate the municipality and county of residence. Use the municipality’s formal name (for example: City of Ashland, Village of Greendale,

or Town of Albion).

 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 (EL-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.

 Provide your home address (legal voting residence) with full house number (including fractions, if any).

 Provide your full street name, including the type (eg., Ave.) 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 may 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 register to vote.

 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.

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.

 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.

 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 10 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.

| Wisconsin Elections Commission P.O. Box 7984, Madison, WI 53707-7984 | 608-266-8005 | web:

EL-121

Rev 2016-08

elections.wi.gov

elections@wi.gov

| email:

Gab-121 - Wisconsin Application For Absentee Ballot Page 2

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