RETURN ADDRESS:
REQUIRES
POSTAGE
________________________________
________________________________
________________________________
DIVISION OF ELECTIONS
ABSENTEE VOTING SECTION
PO BOX 110017
JUNEAU AK 99811-0017
C-06 (REV 12/98)
STATE OF ALASKA ABSENTEE BY MAIL BALLOT APPLICATION
Vote By Mail / Register To Vote
GENERAL INFORMATION:
1. All applications must be received AT LEAST 7 DAYS prior to the election. APPLY EARLY TO RECEIVE YOUR BALLOT
IN TIME.
2
This form is used as a voter registration application and as an application to request an absentee ballot. When registering for the
first time or updating your registration, your application MUST BE POSTMARKED OR RECEIVED 30 DAYS BEFORE THE
DATE OF THE ELECTION.
3. You may apply for absentee ballots on a single application for all statewide elections in the same calendar year as long as the ballots
are sent to the same address. (To vote by mail in city and borough elections you must apply directly to your city or borough clerk.)
4. If you will be in Alaska within 15 days before an election, you may prefer to vote ABSENTEE IN PERSON. Check with any
Division of Elections Office for times and locations throughout the State of Alaska.
5. To assist us in reading your application, please print clearly in ink.
6. If you are an Alaska resident registering from out-of-state, you must provide proof of your Alaska residency, such as a copy of your
current Alaska drivers license, hunting and fishing license, student loan documents, or military leave and earning statements.
7. NOTE TO RESIDENTS TEMPORARILY OUT-OF-STATE: To remain registered in Alaska you must be an Alaska resident
and provide your physical residence address within the State. If you are temporarily outside Alaska, you may wish to maintain your
Alaska residence address as it appears on your current registration record. If you provide a new residence address, it must be within
Alaska.
8.
If you have been convicted of a felony, you may still be eligible to register and/or vote if you have been unconditionally discharged.
Provide a copy of your discharge papers with this registration.
9. The state primary election is held on the fourth Tuesday in August of each even numbered year. The state general election is held
on the first Tuesday after the first Monday in November of each even numbered year.
10. If you are concerned about the confidentiality of your identifying information on your application, you may mail your application in
a separate envelope using the address found on the back of the application.
C-06 (REV 12/98)
JUNEAU: (907) 465-3021
C-06 (REV 12/98)
AS 15.05, .07, .20. 6 AAC 25.
ABSENTEE VOTING SECTION: (907) 465-4611
ANCHORAGE: (907) 522-8683 FAIRBANKS: (907) 451-2835
NOME: (907) 443-5285
ABSENTEE BY MAIL INSTRUCTIONS
Item 1 - NAME. (Mandatory) Provide your last name, first
name, middle initial, and suffix if applicable.
Item 2 - PREVIOUS NAME. (Mandatory) If your name has
changed, provide your previous name.
Item 3 - ALASKA RESIDENCE ADDRESS. (Mandatory)
You must provide the physical location of your residence address
in Alaska. DO NOT USE A MAILING ADDRESS such as PO
Box, Rural or Star Route, Highway Contract No., PSC Box, or a
Commercial Mail Stop.
Item 6 - PLEASE SEND ME BALLOTS FOR THE
FOLLOWING ELECTIONS. (Mandatory) Specify for which
elections you would like to be mailed absentee ballots(s).
Item 7 - PARTY AFFILIATION. Check ONE choice from the
options listed. If selecting “Other,” indicate your affiliation by
writing it on the provided line.
Item 8 - IDENTIFIER. (Mandatory) You MUST provide one
identifier to qualify to receive an absentee ballot(s).
Item 9 - SEX. (Mandatory) Check the appropriate box.
Item 4 - MAILING ADDRESS. (Mandatory) Permanent
Mailing: You may provide a mailing address that is different from
your Alaska residence address. Temporary Mailing: Complete the
temporary address ONLY if your ballot(s) is to be mailed to an
address other than your permanent address.
Check the
appropriate box where you want your ballot(s) sent.
Item 5 - OVERSEAS BALLOTS. If your absentee ballot(s) is to
be sent outside of the United States and if you will be outside of
the United States 60 days prior to and during the election, you may
request a Special Advance Overseas Ballot.
C-06 (REV 12/98)
C-06 (REV 12/98)
Item 10 - SIGNATURE/DATE. (Mandatory) You MUST sign
and date your application. Your application WILL NOT BE
processed without your signature.
1.
First Name
Last Name
2. Previous Name:
M.I.
Suffix (Jr., Sr., III)
For Office Use Only
VN_____________________
D/P ____________________
STATE OF ALASKA ABSENTEE BY MAIL BALLOT APPLICATION
3. Alaska Residence Address: (DO NOT use PO, PSC, or RR Box)
Residence Address
City
ALASKA
Initials__________________
4.
Mailing Address: (Indicate which address ballot is to be sent)
Permanent
City
State
Zip Code
Temporary
City
State
Zip Code
____Received
Reg. Codes Date_________
ABS Codes
5. [ ] Check box if ballot is being sent overseas and you will be overseas 60 days prior to and during the election.
6.
Please send me ballot(s) for the following election(s):
[ ] Primary Election
[ ] REAA/CRSA Election
7. Party Affiliation: (Select Only One)
[ ] Republican Moderate
[ ] General Election
[ ] Alaskan Independence
[ ] Republican
[ ] Non-Partisan
[ ] All In This Calendar Year
[ ] Democrat
[ ] Green
[ ] Other _______________ [ ] Undeclared
8. Identifier: (YOU MUST PROVIDE AT LEAST ONE)
9. Sex
Voter Number___________ Social Security Number_______________________ Birthdate____________
[ ]Male
[ ] Female
10. Voter Certification: I certify under penalty of perjury, that: I am not requesting a ballot from any other state, and I am not voting in any other manner in
this (these) election(s). I also certify that I am a U.S. citizen, and will be 18 years of age or older within 90 days of registration. I further certify that I have not
been convicted of a felony (unless unconditionally discharged). I am not registered to vote in any other state, or I have taken the necessary steps to cancel that
registration.
WARNING: If you provide false information on this application you can be convicted of a misdemeanor.
SIGNATURE:__________________________________
C-06 (REV 12/98)
C-06 (REV 12/98)
DATE:_________________________
Voter Number, SSN, and date of birth are kept confidential and used for identification only.