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)

 

 

_______________________________________________________ญญญ__

                                                  (Address)

 

 

___________________________________________________________________

                                                     (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.