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APPLICATION TO PARTICIPATE IN THE ABSENTEE VOTING PROCESS
FOR THE PERMANENTLY DISABLED
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STATE OF MISSOURI
COUNTY OF CLAY
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| I _______________________________, declare that I am a resident and registered voter of Clay |
| (Print Name) |
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County, Missouri and am permanently disabled. I hereby request that my name be placed on the election authority's list of
voters qualified to participate as absentee voters pursuant to RSMo 115.284, and that I be delivered an absentee
application for each election in which I am eligible to vote.
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| (Signature of Voter) |
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__________________________________________
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| (Voter's Address) |
Mail this application to the Board of Elections Office, 100 W. Mississippi St, Liberty, MO 64068 or fax it to (816) 792-5334. If you have any questions, please call the Election Office at 415-8683.
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