APPLICATION FOR ABSENT VOTER BALLOT REGULAR MUNICIPAL ELECTION – TUESDAY, APRIL 4, 2006 (The last day to submit an application for an Absent Voter Ballot is
Friday, March 31, 2006)
IF YOU COMPLETE AND SUBMIT THIS APPLICATION, YOU CANNOT CHANGE YOUR MIND AND GO TO THE PRECINCT TO VOTE ON ELECTION DAY.
______________________, 2006
Today’s date (required)
To:
Pamela K. Schilling, Town Clerk 101 Midland Avenue Basalt, CO 81621
I, _________________________________________, am a qualified and registered voter in the Town of Basalt, Colorado. My birth date is:___________________________________. I reside at: _________________________________________
Residence Address (required)
_______________________
day-time phone (optional)
in the County of: ____________________________________
(required)
_______________________
evening phone (optional)
Please mail a ballot and necessary supplies for the Tuesday, April 4, 2006 Basalt Election to: Number and Street: City/Town: State/Zip: ____________________________________________
Municipal
__________________________________________________ __________________________________________________
Signature: _____________________________________________________ The Colorado Absent Voter Law requires that, in order for your ballot to be counted, it must reach the Town Clerk's office by 7:00 p.m. Tuesday, the day of the election April 4, 2006. THIS BOX FOR OFFICE USE ONLY Registered: Yes _____ No _____
AV Ballot No.: ______________
av ballot application2006.doc updated 02/06
Date Mailed: ______________