Full Text
2018 Minnesota Absentee Ballot Application Apply online at http://www.mnvotes.org OR Complete lines 1 through 7 below. Please print clearly. Return this application as soon as possible. Ballots must be returned by election day to be counted. Important: Active duty military and overseas voters should not use this application. See the other side for more information. 1. absentee ballots requested for the following election(s) (if no election is marked, a ballot will be mailed for the next election only) 2/13 Special Election 3/13 Township Election 4/10 Special Election 5/8 Special Election 8/14 Primary Election 11/6 General Election Both 8/14 & 11/6 Elections Other (specify date): 2. last name or surname first name middle name suffix 3. date of birth (mm/dd/yyyy) county where you live phone number email address 4. mark all boxes that apply: I have a MN-issued driver’s license or MN ID card. The number is: I have a social security number. The last four digits are: XXX-XX- I do not have a MN-issued driver’s license, MN-issued ID card or a social security number. Your identification number will be compared to the one on your absentee ballot envelope. 5. address where you live (residence) apt. city MN zip code 6. address where your absentee ballot should be sent apt. city state zip code 7. I certify that I: am completing this application on my own behalf; will be at least 18 years old on election day; am a citizen of the United States; will have resided in Minnesota for 20 days immediately preceding election day; maintain residence at the address given on this application form; am not under court-ordered guardianship in which the court order revokes my right to vote; have not been found by a court to be legally incompetent to vote; have the right to vote because, if I have been convicted of a felony, my felony sentence has expired (been completed) or I have been discharged from my sentence; and have read and understand this statement: The above information is accurate, and I sign this application form under penalty of perjury, a felony punishable by not more than 5 years imprisonment, a fine of not more than $10,000, or both. school district precinct reg non-reg official use only received date initials ballot issued date reg non-reg Primary General received date initials ballot issued date type M C HCF type M C HCF repl. date: reason replaced rejected lost spoiled never received repl. date: reason replaced rejected lost spoiled never received See other side for special instructions for voters with disabilities or power of attorney. sign here: date Return this Application to: Anoka County Elections 2100 3rd Avenue, W130 Anoka, MN 55303 Fax: [PHONE REDACTED] Email: [EMAIL REDACTED] Phone: [PHONE REDACTED] - - ---PAGE BREAK--- Return this application as soon as possible to: Anoka County Elections 2100 3rd Avenue, W130 Anoka, MN 55303 Fax: [PHONE REDACTED] Email: [EMAIL REDACTED] Phone: [PHONE REDACTED] Where to return your application You should return this to your local election office. If not provided above, contact information for your local election official can be found under “Find County Election Office” at http://www.mnvotes.org. Options for returning absentee ballot applications For federal, state or county elections, submit an absentee ballot application online at http://www.mnvotes.org. -OR- Paper absentee ballot applications may be returned by mail, fax or as a scanned attachment to an email. When your ballot will be sent Your absentee ballot materials will be sent to you at least 46 days before the election, (excluding town elections held in March where materials will be sent 30 days before the election). If you applied after this date, your ballot will be sent when the application is received. Contact your local election official if you have not received your ballot. To check the status of your absentee ballot, visit http://www.mnvotes.org. Privacy Notice Your exact date of birth, email address, and any ID number you give (Minnesota driver's license, state ID or last four digits of social security number) are private. Only election officials may access it. Election officials ask for your exact date of birth so they can match your application to your voter record. If you refuse to give your date of birth, you won’t get an absentee ballot. Election officials ask for your email so they can contact you about your application. Also, the Office of the Secretary of State may email you (or contact you another way) about voting and elections, or ask for public input. If you refuse to give an email address, you cannot apply for an absentee ballot online and you will need to apply with a paper application. Election officials ask for an ID number to check that the person who is casting the ballot is the same person who applied for it. If you have an ID number but refuse to give it, your absentee ballot might get rejected, and you won’t be able to check your absentee ballot status online. The rest of the data on your application is public when used for elections, political or law enforcement purposes. If you need to keep your contact data private because of personal safety concerns, call 1-[PHONE REDACTED] to learn what you can do. Who may apply for a ballot Each person must apply for themselves. It is a felony to make a false statement in an application for an absentee ballot, to attempt to cast an illegal ballot, or to help anyone to cast an illegal ballot. If you think you may not be registered to vote If you are not registered at the legal residence address provided, you will be sent a voter registration application with your ballot materials. Information for active-duty military and overseas voters If you are applying for an absentee ballot because you or your family are active-duty military or because you will be overseas and/or outside of the territorial limits of the United States, do not use this application. You are entitled to special protections if you apply using the Federal Postcard Application. For more information and to apply online, go to http://www.mnvotes.org. Options available to you if you have a disability You may: sign the application yourself, make your mark, or ask another person to sign for you in your presence (have the person sign their own name as well.) If you have adopted the use of a signature stamp for all purposes of signature, you may use your signature stamp or ask another person to use your signature stamp in your presence. (See Minnesota Statutes, section 645.44, subdivision 14. ) Information regarding Power of Attorney Voting is not covered by power of attorney. A power of attorney pertains only to affairs affecting property. A per- son with power of attorney may only sign for you in your presence, as outlined above. (See Minnesota Statutes, section 523.24, subdivision 14.) Revised 12-20-2017