Division of Civilian Absentee Ballot Application
Elections N.J.S.A. 19:57-1 et seq.
You Must Apply for an Absentee Ballot for Each Election J * I am permanently and totally disabled and wish to receive an
absentee ballot for all elections to be held during the remainder of
I hereby apply for an absentee ballot for the (check one): the calendar year.
J Primary J General J Municipal J Observance of a religious holiday on election day.
J Special J Local School J Regional School J Resident attendance at a school, college or university on election day.
J Voc. Tech. School J Other: J Of nature and hours of my employment on election day.
Under penalty of Law, I certify that the foregoing statements made by me are true and correct
To be held on
Check and Complete Sign your name as it appears in the Registry Book
I live in the
J City J Town J Township J Borough J Village of Print or Type Your Name
Name: If sick or confined a voter may apply for an absentee ballot by authorized
(Name of Messenger)
Zip Code: Phone Number: (Signature of Voter)
Authorized messenger must sign application only in presence
Mail my Ballot to the Following Address: of County Clerk or County Clerk designee.
(Messenger must be a family member or a registered voter, N.J.S.A. 19:57-4)
Municipality: Signature of Messenger:
State: Zip Code: Street Address:
Check Reason for Ballot Municipality: Zip Code:
I am unable to vote at my regular polling place on election day because: A voter may apply for an absentee ballot by mail up to 7 days prior to the election.
J I expect to be absent from the State of New Jersey on election day. He or she may also apply in person to the County Clerk until 3:00 p.m. the day
before the election. Applications are to be returned to the County Clerk in the
Departure Date: County of your last domicile in New Jersey. County Clerk listing are on the reverse
J Of illness or temporary physical disability. side (or page 2) of this form.
J I am permanently and totally disabled, State reason: * Permanently and totally disabled voters have the option of indicating on an application for an
absentee ballot that they would prefer to receive an absentee ballot for each election that
takes place during the remainder of the calendar year.
Elections County Clerks
Atlantic County Clerk Essex County Clerk Monmouth County Clerk Sussex County Clerk
Clerk’s Office P.O. Box 690 300 Halls Mill Road 4 Park Place
5901 Main Street Newark, NJ 07101-0690 Freehold, NJ 07728-1254 Newton, NJ 07860-1795
Mays Landing, NJ 08330-1797 • 973-621-4921 • 732-431-7324 • 973-579-0900
• 609-641-7867 • Fax: 973-621-2527/2537 • Fax: 732-409-4887 and • Fax: 973-383-7493
• Fax: 609-625-4738 732-409-7566
Gloucester County Clerk Union County Clerk
Bergen County Clerk PO Box 129 Morris County Clerk Court House
One Bergen County Plaza 1 North Broad Street PO Box 315 2 Broad Street
Room 130 Woodbury, NJ 08096-3327 Morristown, NJ 07963-0315 1st Floor, Room 115
Hackensack, NJ 07601 • 856-853-3241 • 973-285-6066 Elizabeth, NJ 07207-6099
• 201-336-7020 • Fax: 856-853-3327 • Fax: 973-285-5233 • 908-527-4998/4999
• Fax: 201-336-7002 • Fax: 908-558-2589
Hudson County Clerk Ocean County Clerk
Burlington County Clerk 583 Newark Avenue PO Box 2191 Warren County Clerk
PO Box 6000 Jersey City, NJ 07306-2018 Toms River, NJ 08754-2191 413 Second Street
Mount Holly, NJ 08060-6000 • 201-795-6112 • 732-929-2018 Court House
• 609-265-5189 • Fax: 201-795-2581 • Fax: 732-349-4336 Belvidere, NJ 07823-1500
• Fax: 609-265-0696 • 908-475-6214
Hunterdon County Clerk Passaic County Clerk • Fax: 908-475-6208
Camden County Clerk P.O. Box 2900 401 Grand Street
Election Division Hall of Records Room 130
PO Box 150 Flemington, NJ 08822-2900 Paterson, NJ 07505
Camden, NJ 08101-0150 • 908-788-1214 • 973-225-3632
• 856-225-7219 • Fax: 908-782-4068 • Fax: 973-754-1920
• Fax: 856-756-2213
Mercer County Clerk Salem County Clerk
Cape May County Clerk
PO Box 5000
PO Box 8068
Trenton, NJ 08650-0068
PO Box 18
Salem, NJ 08079-1913
Mail the Civilian
Cape May Courthouse, NJ 08210-5000 • 609-989-6494 • 856-935-7510, ext. 8208 Absentee Ballot
• 609-465-1013 • Fax: 609-989-1111 • Fax: 856-935-8882
• Fax: 609-465-8625 form to the
Middlesex County Clerk Somerset County Clerk
Cumberland County Clerk PO Box 1110 PO Box 3000 County Clerks
PO Box 716
Bridgeton, NJ 08302-2665
New Brunswick, NJ 08901-1110
Somerville, NJ 08876-1262
office in the county
• 856-451-8000, Ext. 211
• Fax: 856-455-1410
• Fax: 732-745-2170 • Fax: 908-253-8853 where you reside.