Shelby County Election Commission Request for Absentee Ballot by Non-Military and Overseas Voters Shelby County General/State & Federal Primary August 6, 2020 First Day to Accept: May 8, 2020 Last Day to Accept: July 30, 2020 Voters Name: _______________________________________ Phone:___________________________ Date of Birth:_______________________ Social Security Number: _____________________ ( ) Entire SSN Required Shelby County Address:___________________________________________________________ Street Address—Be sure to include the apartment number, if any. _______________________________________________ City Memphis This is a primary & general election, so select one: My legal reason for voting Absentee is (Check ONLY One): COVID-19 1. ____ I will be outside of Shelby County during all hours of early voting (7/17/2020 to 8/1/2020) and on Election Day. 2.____ I am enrolled as a full-time student (or spouse of a student) at a college or university outside Shelby County. 3.____ I reside in a license facility (nursing home) outside Shelby County. 12 X._ _ COVID-19 Therefore, I apply to vote absentee by mail. I declare that I reside at the above address; If my address has changed, I have indicated that above; I am a registered voter of Shelby County; and I am eligible to vote in this election. I also declare that I have not previously voted in this election, nor will I attempt to vote at my polling place on Election Day. I swear or affirm, under the penalty of perjury, that all information on this form is true and correct. I understand that if I apply to vote absentee by mail and I am not entitled to do so, I have committed a felony. Voter Signature: ______________________________________ Date:_________ Digital Signature NOT Accepted…..Must be Original Signature Assisting:___________________________________ Date: ___________ Address:_____________________________________________________ If the voter cannot sign or make a mark, the signature and address of the person assisting them and a witness is required. Address to mail ballot to for reasons 1 , 2 & 3, if applicable. Street: City: Memphis State: TN Apt.: Zip: 38116 TN 38116 ______________________________ Zip Code Democratic Primary & General Republican Primary & General General Only Check if new address. 4. ____ I am over 60 years of age. 5. ____ I am a voter with a disability and my polling place is inaccessible. 6. ____ I am hospitalized, ill, or physically disabled, and I am unable to vote in person. 7. ____ I am a caretaker of a person who is hospitalized, ill, or physically disabled. 8. ____ I am a candidate, election official or employee of the Election Commission. 9. ____ I am on jury duty in a state or federal court. 10.____ I am observing a religious holiday that prevents me from voting early or on Election Day. 11.____ I have a Commercial Driver’s License (CDL) or spouse or a person possessing a CDL or a Transportation Worker Identification Credential (TWIC), will be out of county during early voting and Election Day, and have no specific out-of-county or out-of-state address to receive mail during this time. Enclosed is a copy of my CDL or my spouse’s CDL or my TWIC card. The CDL# is ___________________. Witness:_________________________________________ Date:_______________ Address:______________________________________________________________ Questions? Call us at (901) 222-6800. Submit via email to: absenteevoting@shelbycountytn.gov or mail to: Shelby County Election Commission, PO Box 342798, Bartlett, TN 38184-2798
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