2023_absentee_ballot_application_-_fillable.pdf

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This is the Town of Centreville’s 2023 Absentee Ballot Application for the October 2, 2023 Town election from the Board of Supervisors of Elections. It states applicant eligibility (at least 18, resident within corporate limits for 30 days before the election, and registered to vote), requires completion of either Section A (regular absentee request) or Section B (emergency absentee request) plus Section C, and lists the non-emergency application deadline as Monday, September 25, 2023 by 4:30 p.m. Section C lets the applicant choose mailing to a specified address or hand delivery by a registered agent (agent affidavit required); the form requires the applicant’s signature under penalty of perjury and includes staff-use and contact information.

absentee ballot Town of Centreville Board of Supervisors of Elections October 2, 2023 election application deadline Sept 25, 2023 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
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 2, 2023,
for the following reason:
A. Absentee ballot application request is due no later than Monday, September 25, 2023, 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 25, 2023, 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 25, 2023,
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)
2023 ABSENTEE BALLOT Application Rev. 08/29/2023