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State of Idaho County of ____________________


Date: __________________________________, _______

1 Last Name
Residence Address City State

First Name

Middle Name

Sufx (Sr., Jr., etc.)

Phone Number (Optional - which will be public record) Zip Code Email (Optional - which will be public record)

Complete section #2 ONLY if the ballot is to be mailed to an address different than the address in section #1. 2 Mailing Address
City State Zip Code Country (Other than USA)

3 Check the Election(s) for this Absentee Ballot Request 2nd Tuesday in March (School Bond or Levy) 3rd Tuesday in May (Primary Election and/or Taxing Districts Elections) Last Tuesday in August (School Bond or Levy) Tuesday following 1st Monday in November (General Election and/or Taxing Districts Election) Special Emergency Election, if any, to be held on _______________________________, ___________. 2012 Primary Election Only IMPORTANT: To participate in the Primary Election in 2012, every registered elector must either be afliated with one of the 4 recognized political parties or have designated themselves as an "Unafliated" voter (i.e. no party preference). If you have not yet selected a party afliation, you may do it prior to the 2012 Primary Election by completing #4 - Party Afliation below. Any registered elector who has not selected a party afliation or designated themselves as an "Unafliated" voter by the 2012 Primary Election shall be automatically designated as an "Unafliated" voter. Besides selecting a Party Afliation for the 2012 Primary Election, you must also identify the Ballot you wish to receive by completing #5 - Ballot Request below. 4 Party Afliation - Check only one. Constitution Democratic Libertarian Republican Unafliated (i.e. No party preference)

5 Ballot Request IMPORTANT: The Democratic Party is allowing "Unafliated" voters and voters afliated with all other political parties to participate in their Primary Election in 2012. However, only registered Republican voters will be allowed to vote in the Republican Primary. If you are afliated with the Democratic Party, Constitution Party, Libertarian Party or are "Unafliated," select the ballot you wish to receive in the 2012 Primary Election. (Check only one.) Democratic Non-Partisan Ballot Only If you are afliated with the Republican Party, select the ballot you wish to receive in the 2012 Primary Election. (Check only one.) Republican 6
Signature of Voter
EA-4 Primary - Approved Sec. State 2011


Non-Partisan Ballot Only