‘Municipal Clerks for Municipalities in 8th Senate District Municipality ‘Municipal Clerk Adress ‘Giy [Sta] Zip | Phone [Milage of Baysice Lymn Gatyarst__|S075N. Regent Ra [Bayside wi | s32i7|(414) 351-8617 [Vitage of Grown Deer [Russell Van Gompel [4800 W Green Brook DF [Brown Deer wi [83217] 414) 374-3060 [vitage of Fox Point [Tonya CMalley _|7200/N, Santa Monica Blvd Fox Point wi | 53217|(614 351-8600 [ty of Glendale [Susanne Hanaman 5009 N Milwaukee River Pkwy [ctendate Ww | 83206| (14) 228-1718 [Cty of ivaukes [Susan Edman [200 Wells StRm S01 Iwwoukes wi | $3200 | 414) 266-3491 [Vilage of River His [Barbara Goeckner [7650 N Pheasant Ln [River Hs wr | sa217| ora) 352-6213 [vilage of Shorewood | Sheny Grant [3890 N. Murray Ave [Shorewood wi | s3211)(614) 647-2608 [Vilage of Whitefish Bay Jennifer Amero! _|6300N Martborough Dr [whitefish Bay | wi | s2217|(a14) o62-6600 [city af Mequon Lee Saymborski_[11335,N, Cedarburg Rd Mequon wi [ s082| 262) 236-2540 [Vitage of Triensvite [Dianne Robertson [260 Elm St [Thiensvate ‘wi | 52008] 28 242-9720 [Vitage of Germantown [Elizabeth Knaack _[N112 W17001 Mequon Road, P.O, Box 387 [Germantown ‘wi | 52022] 282) 250-4740 [Town ofGermantown [Deanne Hapka _[N125W177%4 Holy HI Ra [Germantown wi | $2022 262) 677-8217 [vtage of Richt [Joshua Schoemann [4128 Hubertus Ra [Riches wi | 52099] 262) 628-2260 [tage of Buter [Timothy Rhode [12821 W Hampton Ave [auter wi | $3007) 282) 783-2525 [Vilage of Menomonee Falls [Janice Moyer [WISGN@480 Pig Ra [Menomonee Fas | wi | 63061262) 532-4210& Wisconsin Application for Absentee Ballot Instructions Each section onthe front side of this document corresponds tothe sections below (17) [General Instructions: [This form should be submitted to your municipal clerk, unless directed otherwise. Please Roview Fully | Ths form should only be completed by registered voters; Hf you are nota registred voter or mutiny elector, please submta Voter Regisvaton Apptcation (GAB-131) wih this form, indicate the municpaly and counly of residence, Use the muniipally’s formal name (For example: City of Plymouth, Vilage of Chenequa, or Town of Aztlan). 2 [+ Provide your name 6s you ae registered fo vata in Wisconsin. W applicable, plaabe provide your sufi (i, St, ‘andlor mise name. i your current name is iferent than how you ao registered to vote, please submit 7 «Provide your month, day and year of ith Remember to uve yout bith year, nt the curent year. {Provan your telephonefex number or mail adress allows elections oficial o contact you # there is 3 problem wih your absentee appiation 3 [> Provde your home aderess (egal voling residence) in Wasconsin, Provide the full house number (nclucing factions, any) = Provide your ul ereet name. including the type (St, Ave.et) and any pre- andor post-crectonal (NS, et) © Provide the ety name and ZIP code aa Rwaould appear on moll delvarod tothe home adaroe. |; Youmay not enter a PO Box a's voting residenea A rural route box without number should net be used. @ [+ Amita elector is @ person or the spouse or dependent ofa person whois a member of@ uniformed service forthe merchant marines, a cilan employee ofthe United Sates, a cian offeially attached oa unformed Service and serving ouside the United States, or a Peace Corp voluneer. ila electors do not need to ‘eglater to Vol, Mary electors wll continue to cole ballots fora elecions unless oherwise requested An Overeaas elector fsa person whois a United Slats czen, 18 years old ox older, who resided in Wisconsin ‘mamediately prio to leaving the United States, who i now ving ouside the United Sttos and has no present Intent to relum, who ls not registered in anyother locaton, or who isan adult cid ofa United States cizen who fesided ints state porto establshing residency abroad. Oversoas electors wil receive ballots fr federsl ‘offices only and must be registered to vote pir fo receiving a balck, 3 |» Pleas fin the exo fo indicate your prefered melhod of receiving your absentee ballet (wall fax or oma), + ifm preference is indicated, your absenton ballot willbe maled to your residence adcess ited in Box 3 {You sre encouraged to provide a physical malin address as backup incase of electronic ansmission Select theft option i you would like to receive a ball fra single election ar a speci sto elections. |S Selec the second option you would Wee to have a standing absentee request or any end allectons that may ‘occur ina calendar year (ending December 31) |= Select the tied option ony you are indefinitely conned due to age, lness,infmiy or dsabty and wish to request sbsente balls fra elacions untl you ae no longer confined or flo return a ballot for an election. 7 [> Tis section is only lobe completed by an elector othe agent of an elector who i currently hospitalized |; Ahosptalized loctor must erly that he or she cannot appear athe pong place on Election Day. An agent completing ths form fora hospitalized elector must prove his/her name, signature and ackess on tis application. |. An absentee apptcation fora hospitalized elector must be witnessed by an elector ofthe hospitalized vote’s ‘municpaliy, withthe winess alo providing hisher address. I the agent sa resident of he Respliaizod voter's ‘unica, helshe canals sgn 38 witness. Signature: By stoning and dating this fom, you cei that you ere a qualified elector, US. ize, at east 18 years old, having resided al your residential access for atleast 10 days immediately preceding his election, nat current ‘Senang.a sentence including probation or parole fora felony conviction, and not etneralce loqualiid rom voting ‘caa 21 REV EROTOA) ‘Wisconsin Application for Absentee Ballot nae eeupsonave (CAPITAL oto ey Flim ccs a oe ‘Youre era ov btn Yoscan care on anerce aba Youca frm you vol gan 6. any (ER INFORMATION [ esacon or compotion ae on te back tha orm Roar tha fro Your mung ck when compe 1 Jranonam [BSE = Lasers [anone Resares Aan Sve Nar & None] pe ner [om Err 7 [ya arti or nasa anc, ine aprpinerce io tower Ch Mita] reese TPREFER TO RECEIVE MY ABSENTEE BALLOT BY: (loa wibe mana assess toeio prlenea nai unin res: Sent Naber 8 None et Na ey sae aze Oman Ning Hone Nine (fans) [ero Womens) TIFAK_|Foxtoner emai [ema ness TREQUEST AN ABSENTEE BALLOT BE SENT TO ME FOR: (rant onyere) {Telcos cn aon te «4 | Clatescions tom cays tough nota caer tend year ern 1290) Mecers eect th et eo aged ro en sb 17 mmr ceo TEMPORARILY HOSPITALIZED VOTERS ONLY mseeminaae) cetyl anaes ath pti pla nena | TOFAS ds Eng BREN AE Oiseau oi So. § 0568. a rato [omavsaa ane AGENT: ety na an hy pporind ager ote ospaiedsbaren cuca, lh tere alo be esate ye csed yn brat fre sore aod aspen dlrs pomp oro by mao al i: Da poet sontre |x agen eres es cry aa aan of bvonbe Sore mmspoy, anda be stone cond hs ppcabn aon wense sae] x vines Aas VOTER DECLARATION / CERTIFICATION (equre trot) Tatil a am aque seca US Cen, oat 8 yea ag ae he ave eal sas fo an 10d leat rocacrg theism ieny Zang serene evar pean o Be ey cvion anda ose ‘Sane far vot, lowe lpn bei a ehrontoge tal You hare ond unacstand he sre serve |x oa ao Gaara REVERT