RECEIPT OF OFFICIAL BALLOTS - DOC - DOC

							           RECEIPT OF BLANK ABSENTEE BALLOTS
       DELIVERED TO CLERK FROM SECRETARY OF STATE

                  General Election ~ November 6, 2012

                         _________________________________________
                                        Municipality


 Received from the Secretary of State on this date the following number of Blank Absentee
 Ballots:

       (Indicate number of ballots and style number – upper left hand corner of ballot)


                  Number of Ballots Received: __________________


                  Style #:___________________




              Signature of Clerk                         Date Received




Please return this form to the Elections Division by fax to 287-6545 or 287-5428
            or by mail (101 State House Station, Augusta, ME 04333).
                                   by August 17, 2012