EARLY VOTING BALLOT APPLICATION
I, __________________________________________, hereby request that an absentee ballot be
(Name)
mailed to me for the _________________ election occurring on __________. I am a registered
(Primary, General, Special) (Date)
voter residing at _______________________________________________________________ ,
(Address, City, St. Zip)
my phone number is ___________________________________ and I am registered to vote as a:
Republican Democratic Nebraska Party Nonpartisan
The ballot should be mailed to me at _______________________________________________.
(Address, City, St., Zip)
_______________________________ (Signature) ___________________________ (Date)