APPLICATION FOR TOWN ABSENTEE BALLOT

Please be advised that the following application must be filled out completely.

If not, it will be returned to you.

Make sure to sign the application

**Please note that this application is only good for one voting period.  Each time you wish

to vote by absentee ballot, you will need to complete another application.

LANCASTER, NEW HAMPSHIRE

APPLICATION FOR OFFICIAL TOWN ABSENTEE BALLOT

To the city or town clerk of _______________________________________

I,____________________________________hereby apply for an official absentee

ballot.  I am a duly qualified voter and entitled to vote in the city or town of

 ____________________________________________________________

                                    (street address)                                                                      (city or town)                              

Mail absentee ballot to:

            (Signature)______________________________________________

            (Mailing Address)__________________________________________

           (City or town, state and country)________________________________