Section 657:4 Forms.
Prior to any state election, the secretary of state shall prepare the appropriate application forms for absentee ballots worded in substantially the following form. The secretary of state shall insert the names of all parties qualified as set forth in RSA 652:11 in the list of parties on the application form. The secretary of state shall prepare the application forms in such quantity as he or she deems necessary:
I. Absence (Excluding Absence Due to Residence Outside the Continental United States), Religious Observance, and Disability:
New Hampshire law requires that you vote in person at the polling place for your town or ward unless you:
a. Plan to be absent on the day of the election from the city, town, or unincorporated place in which you are registered to vote.
b. Cannot appear in public on election day because of observance of a religious commitment.
c. Are unable to vote in person due to a disability.
d. Cannot appear at any time during polling hours at your polling place because an employment obligation requires you to remain physically at work or to be in transit to or from work from the time the polls open until after the time the polls close.
RSA 657:1. Any person who votes or attempts to vote using an absentee ballot who is not entitled to vote by absentee ballot shall be guilty of a misdemeanor. RSA 657:24.
I am requesting an absentee ballot for the following election:
___ State Primary. I am member of the:
___ Republican Party
___ Democratic Party
or I am now declaring my affiliation with that party and am requesting a ballot for that party's primary.
___ General Election
Applicant's Name
__________________________________________________
(Last) (First) (Middle)
Applicant's Voting Domicile (home address):
__________________________________________________
(Street) (City/Town) (zip)
Mail the ballot to me at this address:
______________________________
______________________________
______________________________
I hereby declare that:
___ I am a duly qualified voter who is currently registered to vote in this town/ward.
___ I am absent from the town/city where I am domiciled and will be until after the next election, or I am unable to register in person due to a disability, and request that the forms necessary for absentee voter registration be sent to me with the absentee ballot.
I will be entitled to vote by absentee ballot at the election designated above because:
___ I plan to be absent on the day of the election from the city, town, or unincorporated place where I am domiciled.
___ I am requesting a ballot for the presidential primary election and I may be absent on the day of the election from the city, town, or unincorporated place where I am domiciled, but the date of the election has not been announced. I understand that I may only make such a request 14 days after the filing period for candidates has closed, and that if I will not be absent on the date of the election I am not eligible to vote by absentee ballot.
___ I cannot appear in public on election day because of observance of a religious commitment.
___ I am unable to vote in person due to a disability.
___ I cannot appear at any time during polling hours at my polling place because an employment obligation requires me to remain physically at work or to be in transit to or from work from the time the polls open until after the time the polls close.
This application form must be signed by the applicant. The absentee ballot forms you receive will require you to sign an affidavit confirming that you are entitled to vote by absentee ballot due to one of the reasons stated above. The moderator is required to compare the signature on the affidavit to your signature on this form. The absentee ballot will not be counted if the affidavit and this form do not appear to have been signed by the same person. RSA 659:50.
| ________________________________ |
| Signature of the Applicant |
II. Any person that publishes, mails, or distributes in any manner any written communication that contains a form or postcard which a reasonable person would consider as intended to be used by the recipient of the communication to submit a request for an absentee ballot shall attach a copy of the form prepared by the secretary of state pursuant to paragraph I of this section to the communication or include in the communication a complete facsimile of the form prepared by the secretary of state pursuant to paragraph I of this section. Any person that violates this paragraph shall be subject to a civil penalty not to exceed $1,000, to be imposed in the manner set forth in RSA 659:34, III-V.
III. (a) Absence Due to Residence Outside the Continental United States:
To the city or town clerk of ____________________
I, __________, hereby apply for an official absentee ballot. I am a duly qualified voter and entitled to vote in ward ___, city or town of __________.
Mail absentee ballot to ____________________.
City or Town, State and Country
|
(b) Overseas Voting:
To the city or town clerk of ____________________
I, __________, hereby apply for an official overseas citizens federal election absentee ballot. I am a duly qualified overseas voter and entitled to vote in federal elections held in the city or town of _____. Mail overseas citizens federal election absentee ballot to ____________________.
City or Town, Province, Country
|
(c) Armed Services Voting:
To the town or city clerk of ____________________
I, __________, hereby apply for an official armed services absentee ballot. I am:
a. A member of the armed forces of the United States. Service ( ) Organization ____________________ b. A member of the merchant marine of the United States. ( ) c. A civilian employee of the United States government serving outside ( ) the United States. d. A member of a religious group or welfare agency assisting members ( ) of the armed forces. Organization ____________________ e. A spouse or dependent of a person listed in a, b, c, or d above. ( )
My complete service address is:
____________________
____________________
____________________
____________________
My (non-military) domicile in New Hampshire immediately prior to such service was: street and number __________ city or town ____________________
Source. 1979, 436:1; 308:3, 4. 1988, 73:3. 2006, 136:5. 2007, 212:2, eff. June 25, 2007. 2009, 288:2, eff. Sept. 27, 2009.