Application for Absent Voter’s Ballots

For Franklin County, Nebraska

Date________________________

I the undersigned, say that my voting residence in Nebraska is:

(Street Address)

(Postal Address)

(City)                                                                                          (State)                                                                                (Zip)

My election precinct and polling place is:

□ Campbell – Campbell Community Hall

□ Hildreth – Hildreth Municipal Building

□ East Franklin – Evangelical Free Church

□ West Franklin – Grace Lutheran Church

I am a registered voter of the State of Nebraska.  I request ballots be mailed to:

(Street Address)

(Postal Address)

(City)                                                                                            (State)                                                                                (Zip)

I affiliate with the □ Republican  □ Democrat  □ Nonpartisan  □ Nebraska  □ Green  □ Libertarian political party.  I may be reached at this phone number (         ) ________________________ by the County Clerk or Election Commissioner to verify any information which might be required before sending ballots.

(Print Voter Name Here)

(Voter Sign Here)

(Spouse, Parent, Son or Daughter or Person Appointed as Agent)

Mail to:  Marcia Volk, Franklin County Clerk, P.O. Box 146, Franklin, NE 68939-0146