2022-absentee-ballot-application.pdf

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This is the Town of Centreville application form for an absentee ballot for the October 3, 2022 town election. It states applicant eligibility (age 18+, registered to vote, resident within town limits for 30 days before the election), a regular-application deadline of Monday, September 26, 2022 by 4:30 p.m., and emergency absentee grounds that apply after that deadline (illness/accident or death/serious illness in immediate family). Applicants must choose how to receive the ballot (mail/email/in-person) or designate a registered Centreville voter to hand-deliver it (agent affidavit required), provide a signature under penalty of perjury, and the form includes town contact and staff-use fields.

absentee ballot Town of Centreville October 3, 2022 election application deadline Sept 26, 2022 emergency absentee agent delivery voter eligibility

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The Town of Centreville
BOARD OF SUPERVISORS OF ELECTIONS
101 Lawyer’s Row
Centreville, Maryland 21617
410-758-1180
APPLICATION FOR ABSENTEE BALLOT
My address of residence is: , Centreville, Maryland 21617
I, (full name) am at least eighteen years of age,
have resided within the corporate limits of the town for 30 days preceding the Town election, and am
registered to vote.
Complete Section A or B, as well as Section C.
I hereby apply for an Absentee Ballot for the Centreville Town Election to be held on October 3, 2022
for the following reason:
A. Absentee ballot application request is due no later than Monday, September 26, 2022, by 4:30 p.m.:
 I will be absent on Election Day from the Town of Centreville for any reason.
{Centreville Code 50-7.A}
B. Emergency absentee ballot application request: (Check one)
 I will be unable to be present at the polls as a result of illness or accident occurring after
the Monday, September 26, 2022 application deadline for absentee ballots. {Centreville
Code 50-7.B.1}
 I will be unable to be present at the polls because of a death or serious illness in my
immediate family of which I became aware after the Monday, September 26, 2022
application deadline for absentee ballots. {Centreville Code 50-7.B.2}
C. Check one:
 I have applied in person, via email, or via mail, and request that the absentee ballot is sent
to me at the following address:
□
Staff Use Only: Applied in person (Initials)
 I request that the absentee ballot be hand delivered to me by the following agent, who is
registered to vote in the Town of Centreville, hereby designated by me. {Centreville Code
50-7.C} (Agent’s Affidavit is required).
Agent:
I hereby affirm under the penalty of perjury under the laws of Maryland that all of the above statements
are true to the best of my knowledge and belief.
(Signature) (Print Name)
2022 ABSENTEE BALLOT Application.doc Rev. 08/10/2022