Free DECLARATION OF INTENT TO BE A WRITE-IN CANDIDATE (VRG-22) - Indiana


File Size: 644.0 kB
Pages: 1
Date: October 18, 2007
File Format: PDF
State: Indiana
Category: Government
Author: Valued Gateway Client
Word Count: 548 Words, 3,221 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.state.in.us/icpr/webfile/formsdiv/51263.pdf

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AFFIDAVIT FOR LATE VOTER REGISTRATION BY ABSENT UNIFORMED SERVICES VOTER FOR THE PRIMARY AND GENERAL ELECTION
State Form 51263 (R6 / 10-07) Indiana Election Commission (IC 3-7-36-11; 3-7-36-14)

Reset Form

(ABS-13)

INSTRUCTIONS: This affidavit is used only for an absent uniformed services voter (or the voter's spouse or dependent) who is otherwise entitled to vote in Indiana if the voter was absent from Indiana during the previous registration period. This voter may apply to register to vote after the close of registration and after the poll list is printed until noon election day if the voter: (1) returned to Indiana after the poll list is prepared, but before noon election day; (2) shows the county registration office a discharge dated on or after the beginning of the preceding registration period or a government movement order with a reporting date on or after the beginning of the preceding registration period; (3) completes a registration application; and (4) signs an affidavit that the voter has not voted at any other precinct in the election. A voter who registers under this procedure is entitled to vote in the upcoming election by absentee ballot at the office of the circuit court clerk any time after the voter registers and until noon election day.
STATE OF INDIANA COUNTY OF ____________________________________

I affirm each of the following: 1. I am either: (a) A member of a uniformed service on active duty who, by reason of active duty, was absent from the place of my residence where I am otherwise qualified to vote; (b) A member of the merchant marine who, by reason of service in the merchant marine, was absent from the place of residence where I am otherwise qualified to vote; (c) A member of the Indiana national guard deployed or on assignment outside Indiana; or (d) A spouse or dependent of a member referred to in (a), (b) or (c) above who, by reason of the active duty or service of the member, is absent from the place of residence where the spouse or dependent is otherwise qualified to vote. 2. I have been absent from Indiana by reason of my service (or I am the spouse or dependent of a member described in paragraph 1(a), (b) or (c) and have been absent from Indiana by reason of that member's service) as indicated in paragraph 1 since December 3, 2007, through April 7, 2008, for the primary election OR since May 20, 2008, through October 6, 2008 for the general election. 3. I returned to Indiana after April 7, 2008, and on or after preparation of the poll list for my precinct, but before noon election day, May 6, 2008, for the primary election OR I returned to Indiana after October 6, 2008, but before noon election day, November 4, 2008, for the general election. 4. I (or my spouse or dependent) have shown the county registration official a discharge dated on or after December 3, 2007, or a government movement order with a reporting date on or after December 3, 2007, for the primary election OR dated on or after May 20, 2008, for the general election. 5. I have completed a registration application. 6. I have completed an absentee ballot application. 7. I have not voted at any other precinct in this election.
Name of Voter Printed Name of Voter