IMPORTANT: Complete and sign this application. Fold application so the mailer above faces out. TAPE closed. Mail promptly.
Place
Stamp
Here
Applicant’s Return Address
County Board of Elections
Fold ABSENTEE BALLOT APPLICATION FOR MARYLAND VOTERS Fold
Fold Fold
PRINT NAME AND ADDRESS AS REGISTERED:
Last Name _____________________________________________ First _______________________________________ Middle ______________________
No./Street _____________________________________________________________________________ Apt: ____________________________________
City ___________________________________________________ State _______________________________________ Zip ________________________
Date of Birth _______________________________ Party Affiliation ____________________________________ Phone No. __________________________
MAILING ADDRESS, IF DIFFERENT FOR PRIMARY ELECTION:
No./Street _____________________________________________________________________________ Apt: ____________________________________
City ___________________________________________________ State _______________________________________ Zip ________________________
MAILING ADDRESS, IF DIFFERENT FOR GENERAL ELECTION:
No./Street _____________________________________________________________________________ Apt: ____________________________________
City ___________________________________________________ State _______________________________________ Zip ________________________
NOTE: Provide the mailing address at which mail reaches you most promptly. If this address changes prior to any election, you must notify
the board of elections to assure receipt of your ballot.
WARNING: Any person who is convicted of violating the absentee voting law is subject to a fine of up to $1,000, imprisonment for up to
2 years, or both. (Election Law Article, Section 9-312, Annotated Code of Maryland)
Signature of Voter ___________________________________________________________ Date __________________________________
CERTIFICATE OF ASSISTANCE
Under penalty of perjury, I hereby certify that the voter named above, who requires assistance because of disability or inability to read or write,
authorized me to complete this application for him/her. If the voter was unable to sign this application, I have printed the voter’s name on the
Signature of Voter line, followed by my initials.
Signature of Assistant _________________________________________________________ Date __________________________________
Printed Name of Assistant ______________________________________________________________________________________________
Please send me an absentee ballot for the upcoming: Primary Election General Election Both Elections
Check here if this is your new legal residence. If it is, did you change residences before or after January 22, 2008?
Check here if this is your new legal residence. If it is, did you change residences before or after October 14, 2008?
IMPORTANT NOTE: If you complete and submit this form, you must affirm on the oath that is returned with your voted
ballot that you "will be absent or unable to vote in person in the election." If you will not be absent or are able to vote in person
in