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STAT.]
PUBLIC LAW 296-AUG. 9, 1955 F I L L OUT BOTH S I D E S OF CARD POST CARD APPLICATION FOR A B S E N T E E BALLOT
State or Commonwealth of (Fill In name of State or Commonwealth) (1) I hereby request an absentee ballot to vote in the coming election: (GENERAL) (PRIMARY)* (SPECIAL) ELECTION (Strike out inapplicable words) (2) * If a ballot is requested for a p r i m a r y election, print your political I party affiliation or preference in this box: I (If primary election is secret in your State, do not answer) (3) I am a citizen of the United States, eligible to vote in above State, and am: a. A member of the Armed Forces of the United States b. A member of the merchant marine of the United States c. A member of a religious or welfare organization assisting servicemen d. A civilian employed by the United States Government outside the United States (continental) e. A spouse or dependent of a person listed in (a), (b), or (c) above f. A spouse or dependent residing with a person described in (d) above (4) I was born on (Day) (Month) (Year) (5) For years preceding the above election my home (not military) residence in the above State has been (Street and number or r u r a l route, etc.) The voting precinct or election district for this residence Isi (6) R e m a r k s:
( Enter if known)
(7) Mail my ballot to the following official address: (Unit (Co., Sq., Trp., Bn., E t c.), GovernmentafXgency, orlofflcej (Military Base, Station, Camp, Fort, Ship, Airfield, etc.) (Street No., APO, or F P O No.) (City, Postal Zone, and State) (8) I am NOT requesting a ballot from any other State and am not voting in any other manner in this election, except by absentee process, and have not voted and do not intend to vote in this election a t any other address. (9) (Signature of person requesting ballot) (10) (Full name, typed or printed, with rank or grade, and service number) (11) Subscribed and sworn to before me on (Day, month, and year) (Signature of official administering oath)
(Typed or printed name of official administering o a t h)
(Title or rank, service number, ahd organization of administering official) INSTRUCTIONS
A. Before filling out this form see your voting officer in regard to the voting laws of your State and absentee registration and voting procedure. B. Type or p r i n t all entries except signatures. F I L L OUT BOTH S I D E S OF CARD. C. Address card to proper State official. Your voting officer or commanding officer will furnish you his title and address. D. Mail card as soon as your State will accept your application. E. NO postage is required for the card.
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