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Get NV EL315 2012

Irth (mm/dd/yyyy) Nevada: Driver's License, ID Card, or Voter Registration Number (if Known) 3 Address For Mailing The Absent Ballot (If Different from #2) City State Zip Code 4 Mark Election(s) Which You Are Requesting An Absent Ballot: Primary General Special All Civilian Overseas At Least 65 Years of Age 5 Mark One Reason For Absent Ballot Request: Military Domestic Military Overseas Physical Disability Other Please Sign And Date Below: 6 X Signature Date WARNING! FOR OFF.

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