Precinct ________________                 Party________               Voter ID# _________________


Above this line - Office Use Only


Early Voting (Absentee) Ballot Request Form

Kimball County, Nebraska


The penalty for election falsification is imprisonment for up to five years,

or a fine not to exceed $10,000.00 or both.


I, _______________________________, declare my voting residence is:

                             (Printed Name)








                                                     (City, State, Zip)


I am a qualified elector of the State of Nebraska and request early voting


ballots for the ________________ election occurring _______________.

                         (Primary, General, Special)                                     (Date)


The ballots should be mailed to me at:



                                          (Mailing Address)



                                                (City, State, Zip)


_____________________________          __________________

              (Signature of Voter)                                            (Date)


_____________________________          __________________

    (Signature of agent other than voter)                       (Phone Number)



Return To:

Please Note:

Kimball County Clerk

All Early Voter (Absentee) ballots

114 E 3rd Street, Ste 6

must be received by the County

Kimball, NE 69145

Clerk by 7:00 p.m. on Election Day


in order to be counted.