Get MP Application for Absentee Voting 2012

I hereby request Absentee Ballot for the following election s General Election Run-Off Election If Applicable Section II. COMMONWEALTH ELECTION COMMISSION APPLICATION FOR ABSENTEE VOTING CNMI Registered Voters Only Section I. Applicant s Information Print clearly in black/blue ink. Last Four 4 Digits of Social Security Number X X X -X X- Failure to complete all items will prevent acceptance of this application Date of Birth Last Name First Name Contact No* Gender Circle One M ale Fem ale Middle Island ZIP Code Residential Address CNMI Must be completed No P. O. Box or General Delivery Mailing Address CNMI Street Address P. O. Box or General Delivery Home Business Other Reason for Absence / / Section III. Please mail my ballot s to Print clearly in black/blue ink. Special Election If Applicable Name Forwarding Address Including zip Code myself and no other and 3 all information furnished on this application is true and correct. Signature of Applicant Date Witness Signature required only if applicant makes a mark Address of Witness Contact No* of Witness Notice A Pursuant to CNMI Election Statute the Commonwealth Election Commission may use this application to transfer a voter to the proper election precinct/district to correspond with the address given above. Offical Use Only Election Clerk/Worker Ballot Type Ballot Mailed on General By Ballot Received on District/Precinct Remarks. Applicant s Information Print clearly in black/blue ink. Last Four 4 Digits of Social Security Number X X X -X X- Failure to complete all items will prevent acceptance of this application Date of Birth Last Name First Name Contact No* Gender Circle One M ale Fem ale Middle Island ZIP Code Residential Address CNMI Must be completed No P. O. Box or General Delivery Mailing Address CNMI Street Address P. O. Box or General Delivery Home Business Other Reason for Absence / / Section III. O. Box or General Delivery Mailing Address CNMI Street Address P. O. Box or General Delivery Home Business Other Reason for Absence / / Section III. Please mail my ballot s to Print clearly in black/blue ink. Special Election If Applicable Name Forwarding Address Including zip Code myself and no other and 3 all information furnished on this application is true and correct. Please mail my ballot s to Print clearly in black/blue ink. Special Election If Applicable Name Forwarding Address Including zip Code myself and no other and 3 all information furnished on this application is true and correct. Signature of Applicant Date Witness Signature required only if applicant makes a mark Address of Witness Contact No* of Witness Notice A Pursuant to CNMI Election Statute the Commonwealth Election Commission may use this application to transfer a voter to the proper election precinct/district to correspond with the address given above. Signature of Applicant Date Witness Signature required only if applicant makes a mark Address of Witness Contact No* of Witness Notice A Pursuant to CNMI Election Statute the Commonwealth Election Commission may use this application to transfer a voter to the proper election precinct/district to correspond with the address given above. Offical Use Only Election Clerk/Worker Ballot Type Ballot Mailed on General By Ballot Received on District/Precinct Remarks. .