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Application for Absentee Ballot for Flathead County Including Request for Absentee Ballot due to Illness or Health Emergency Please Return form to: For School Elections, please return this form to the appropriate school. For all other elections, return to: Flathead County Election Dept 800 S Main St Kalispell, MT 59901 Fax to: (406) 758-5877 SECTION 1 - SUBMIT COMPLETED FORM NO SOONER THAN 75 DAYS BEFORE THE ELECTION AND NO LATER THAN NOON THE DAY BEFORE THE ELECTION. Elector Name Birthdate County where registered Phone: Residence address in Flathead County Street City Zip I hereby request an absentee ballot for the: (check one or all three if you want a ballot for all elections ‐if all three see section 3 below) Primary General Municipal Other election to be held on , 20 Month/Day Year If applying for a ballot to be sent to you, address where ballot will be mailed: Street/PO Box/Other City , State Zip Country (if outside USA) By signing below, I understand that I am officially requesting an absentee ballot. **Also sign affidavit at bottom of page if requesting due to illness or health emergency.** Signature of Elector Date Signed Section 2 Optional –Voter Information Pamphlet Request (an electronic version of this pamphlet can be found at sos.mt.gov) Please send current Voter Information Pamphlet, if applicable to this election Section 3 Optional –Annual Absentee List – By checking one of the boxes below, I understand that I will be mailed an absentee ballot for applicable elections that I am qualified to vote in, as long as I reside at the address listed above, and as long as I complete and return a confirmation notice mailed to me by the county election office each year in January. I UNDERSTAND I MUST COMPLETE AND RETURN AN ANNUAL ADDRESS CONFIRMATION NOTICE TO REMAIN ON THE ABSENTEE LIST. All elections (includes schools and special district elections) All federal elections only (ONLY Federal Primary election ballots and Federal General Election Ballots) Section 4 Optional –Designation of another person to pick up absentee ballot I, the elector who signed above, hereby designate to pick up my absentee ballot. Section 5 Optional –Receipt of absentee ballot by designee On this of I received the absentee ballot for the above named applicant. Signature of designee Date WHERE TO RETURN VOTED BALLOT AFFIDAVIT OF ELECTOR (DUE TO ILLNESS OR HEALTH EMERGENCY) Return voted absentee ballots to your county election office no later than close of polls on election day, or to your polling place on election day. County election office mailing address: Flathead County Election Department 800 S Main Kalispell, MT 59901 Ballots mailed to the county election office must be received no later than 8:00 p.m. on election day. Optional: I hereby declare that I am prevented from voting at the polls due to illness or health emergency occurring between 5:00 p.m. on the Friday preceding the election and noon on election day. Signature of Elector and Date Signed