TO THE CLERK OF FITZWILLIAM I, __________________________________________________,
(PRINT FULL NAME)
HEREBY DECLARE THAT: (CHECK ONE THAT APPLIES)
- I AM A DULY QUALIFIED VOTER WHO IS CURRENTLY REGISTERED TO VOTE IN THE TOWN OF FITZWILLIAM.
- 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 AN ABSENTEE VOTER REGISTRATION BE SENT TO ME WITH THE ABSENTEE BALLOT.
WILL BE ENTITLED TO VOTE BY ABSENTEE BALLOT AT THE ELECTION DESIGNATED ABOVE BECAUSE: (CHECK ONE THAT APPLIES)
- I PLAN TO BE ABSENT ON THE DAY OF THE ELECTION FROM THE CITY, TOWN OR UNINCORPORATED PLACE WHERE I AM DOMICILED.
- I CANNOT APPEAR IN PUBLIC ON ELECTION DAY BECAUSE OF OBSERVANCE OF A RELIGIOUS COMMITMENT.
- I AM UNABLE TO VOTE IN PERSON DUE TO 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.
(SIGNATURE) (LOCAL ADDRESS)
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 reason 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.
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
MAIL ABSENTEE BALLOT TO: MAIL/FAX COMPLETED APPLICATION TO:
_____________________________________ HEIDI L. WOOD, FITZWILLIAM TOWN CLERK
PO BOX 725, 13 TEMPLETON TNPK.
_____________________________________ FITZWILLIAM, NH 03447
TEL:(603) 585-7214 FAX:(603) 585-7744
- PLEASE INCLUDE SCHOOL BALLOT(S) TOO