Alabama Application for Emergency Absentee Ballot
The following application is used to determine a voter’s eligibility for certain types of elections in the State of Alabama.
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APPLICATION FOR EMERGENCY ABSENTEE BALLOT FORM AV-E1 ______________________ COUNTY, ALABAMA When I apply for this absentee ballot, I understand that my name will be stricken from the list of qualified electors and, when I cast this absentee ballot, I understand that I will not be entitl\ ed to vote at my regular polling place. The voter, or his or her designee in the case of a medical emergency, may hand this application to the Absentee Election Manager. Except in the case of a business emergency, the voter may also forward this application to the Absentee Election Manager by U.S. Mail [§17-11-3 and §17-11-4, Code of Alabama, 1975]. READ PENALTIES ON BACK Voter’s Signature Witness Signature Print Witness Name Complete this section if voter signs by mark Street Address (address where you are registered to vote; do not use PO box) Mail my ballot to the address where I regularly receive mail, if different from the street address provided above. Precinct where you vote (name and/or location of your polling place) Work Telephone Number Date of Birth Home Telephone Number General Voter Information - Please provide complete information so that we may verify your eligibili\ ty to vote. For all registered voters PHYSICIANS REPORT FOR MEDICAL EMERGENCY Physician shall describe and certify the circumstances as constituting t\ he emergency. Physician’s Signature Date ASSIGNMENT OF DESIGNEE FOR DELIVERY OF APPLICATION An application for an emergency medical absentee ballot may be forwarded\ to the Absentee Election Manager by the applicant or his or her designee. If assigning a designee, complete this\ section. Printed Name of Designee Signature of Designee I will be unable to vote at my regular polling place on election day bec\ ause (check one reason): I have a medical emergency. Complete the Physician’s Report below. The physician’s report must be signed by a physician. [If the physician’s report is on a separate document, attach it to this application. This application may be delivered by a designee. If assigning a designee, complete the Designee \ section at the bottom of this form.] I have a business emergency. By signing this application, I do solemnly swear or affirm that I was not aware of the out-of-county business requirement prior to the five (5) days before the election. [The voter must deliver the application by hand to the Absentee Election Manager during the five (5) days prior to the election.] City ZIP Year Day Month ( ) ( ) Last Name (Please print) First Name Middle or Maiden Name Driver’s License Number S TAT E NUMBER IF NO DRIVER’S LICENSE NUMBER Last 4 digits of Social Security number E-mail Address Return this application to: Primary Election or Presidential Preference Primary Select one: I hereby make application for an absentee ballot so that I may vote in t\ he following election: Democratic Party Republican Party Other ____________ Amendments Only Primary Runoff Election Select one: Democratic Party Republican Party Other ____________ Amendments Only General Election Special Election ( specify ) ________________________ n Absentee ballots for elections more than 42 days apart must be requested\ on separate applications, unless you are a member of the armed forces, or a spouse or dependent of such person, or you are a United States citizen residing overseas. n An application submitted by a member of the armed forces, or a spouse or dependent of such person, or a United States citizen residing overseas, is valid for all county, state and federal elections in the current calendar year. For Office Use Only Municipal Election PENALTIES §17-17-24, Code of Alabama, 1975, as amended (a) Any person who willfully changes an absentee voter’s ballot to the extent that it does not reflect the voter’s true ballot, any person who willfully votes more than once by absentee b\ allot in the same election, any person who willfully votes for another voter or falsifies absentee ballot applications or verification documents so as to vote absentee, or any person who solicits, encourages, urges, or otherwise promotes illegal absentee voting, shall be guilty, upon conviction, of a Class C felony. Any person who willfully aids any person unlawfully to vote an absentee ballot, any person who knowingly and unlawfully votes a\ n absentee ballot, and any voter who votes both an absentee and a regular ballot at any election shall be sim\ ilarly punished. (b) Upon request by the local district attorney or the Secretary of St\ ate, the Attorney General shall provide investigating assistance in instances of absentee ballot or voting viola\ tions. (c) Nothing in this section shall be construed to impede or inhibit or\ ganized legal efforts to encourage voter participation in the election process or to discourage a candidate from \ encouraging electors to lawfully vote by absentee ballot.Relevant article from our knowledge database
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