Absentee Ballot

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This is the Town of Centreville’s official application form to request an absentee ballot for the Centreville Town Election on October 7, 2024. It requires the applicant’s full name, Centreville residence, voter eligibility (18+, resident within corporate limits for 30 days before the election, and registered), and selection of either a regular absentee request (deadline Monday, September 30, 2024 by 4:30 p.m.) or an emergency absentee reason (illness/accident or death/serious illness in immediate family occurring after the deadline). Section C asks whether the ballot should be mailed/sent to a provided address or hand-delivered by a designated agent (agent must be a registered Centreville voter and submit an Agent’s Affidavit). The form must be signed under penalty of perjury; contact information for the Board of Supervisors of Elections and a revision date (07/10/2024) are shown.

absentee ballot Centreville October 7, 2024 election deadline September 30, 2024 emergency absentee agent delivery Board of Supervisors of Elections

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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
I, (full name) am at least eighteen years of age,
have resided within the corporate limits of Centreville for 30 days preceding the Town election, and am
registered to vote.
My address of residence is: , Centreville, Maryland 21617
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 7, 2024,
for the following reason:
A. Absentee ballot application request is due no later than Monday, September 30, 2024, 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 30, 2024, 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 30, 2024,
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 (Please print):
□
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)
2024 ABSENTEE BALLOT Application Rev. 07/10/2024