Details for SEA ISLE CITY - LEGAL

NOTICE TO PERSONS WANTING MAIL-IN BALLOTS
Borough of Avalon • City of Sea Isle City

If you are a qualified and registered voter of the State who wants to vote by mail in the Municipal Election to be held on May 14, 2019
complete the application form below and send to the undersigned, or write or apply in person to the undersigned at once requesting that
a mail-in ballot be forwarded to you. The request must state your home address and the address to which the ballot should be sent. The
request must be dated and signed with your signature.
If any person has assisted you to complete the mail-in ballot application, the name, address and signature of the assistor must be
provided on the application and, you must sign and date the application for it to be valid and processed. No person shall serve as an authorized messenger for more than three qualified voters in an election. No person who is a candidate in the election for which the voter
requests a mail-in ballot may provide any assistance in the completion of the ballot or may serve as an authorized messenger or bearer.
No mail-in ballot will be provided to any applicant who submits a request therefor by mail unless the request is received at least seven
days before the election and contains the requested information. A voter may, however, request an application in person from the county
clerk up to 3 p.m. of the day before the election.
Voters who want to vote only by mail in all future general elections in which they are eligible to vote, and who state that on their application shall, after their initial request and without further action on their part, be provided a mail-in ballot by the county clerk until the
voter requests that the voter no longer be sent such a ballot. A voter’s failure to vote in the fourth general election following the general
election at which the voter last voted may result in the suspension of that voter’s ability to receive a mail-in ballot for all future general
elections unless a new application is completed and filed with the county clerk.
Voters also have the option of indicating on their mail-in ballot applications that they would prefer to receive mail-in ballots for each
election that takes place during the remainder of this calendar year. Voters who exercise this option will be furnished with mail-in ballots
for each election that takes place during the remainder of this calendar year, without further action on their part.
Application forms may be obtained by applying to the undersigned either in writing or by telephone, or the application form provided
below may be completed and forwarded to the undersigned.
Dated: March 13, 2019
Rita Marie Fulginiti, County Clerk
County of Cape May
7 North Main Street
PO Box 5000
Cape May Court House, NJ 08210-5000

ApplicAtion For Vote

by

MAil bAllot

Please type or print clearly in ink. All information required unless marked optional.

I hereby apply for a Mail-In Ballot for:

MILITARY/OVERSEAS VOTER ONLY

(CHECK ONLY ONE)

I request Vote-By-Mail Ballots for all elections in which I am
eligible to vote and I am (CHECK ONLY ONE)

r ALL FUTURE ELECTIONS, until I request otherwise in writing.

1

Or for ONLY ONE of the following: r General (November)
r Primary (June) r Municipal r School r Fire
r Special _______________
(Specify)

/

To be held on

/

(MM / DD / YYYY)

r A Member of the Uniformed Services or Merchant Marine on
active duty, or an eligible spouse or dependent.
r A U.S. Citizen residing outside the U.S. and I intend to return.
r A U.S. Citizen residing outside the U.S. and I do not intend to return.
r A U.S. Citizen residing outside the U.S. and I have never lived in the U.S.

PLEASE NOTE: Your ballot can only be sent to the mailing address supplied on this application.
If your mailing address changes, you must notify the County Clerk in writing.

2

Last Name (Type or Print)

First Name (Type or Print)

Address at which you are registered to vote:

3
5
8

State

Municipality (City/Town)

Date of Birth (MM / DD / YYYY)

/

/

Signature

4

Zip

Please include
any PO Box, RD#,
State/Province,
Zip/Postal Code
& Country
(if outside US)

Day Time Phone Number

6

(

Suffix (Jr., Sr., III)

Mail my ballot to the following address:
r Same Address as Section 3

Apt.

Street Address or RD#

Middle Name or Initial

7

)

E-Mail Address (Optional)

Please sign your name as it appears in the Poll Book.

X ______________________________

9

Today’s Date (MM / DD / YYYY)

/

/

OPTIONAL - ONLY COMPLETE SECTIONS 10 OR 11 IF APPLICABLE

Assistor:

10

Any person providing assistance to the voter in completing this application must complete this section.

Name of Assistor (Type or Print)

Date (MM / DD / YYYY)

Signature of Assistor

X
Address

/

Municipality (City/Town)

Apt.

State

/

Zip

Authorized Messenger:

Any voter may apply for a Mail-In Ballot by Authorized Messenger. Messenger shall be a family member or a registered voter of this
County. No Authorized Messenger can (1) be a Candidate in the election for which the voter is requesting a Mail-In Ballot or (2) serve
as messenger for more than THREE qualified voters per election.

I designate ____________________________________________ to be my Authorized Messenger.
Address of Messenger

11 Signature of Voter
STOP

Print Name of Authorized Messenger

Apt.

Municipality (City/Town)

Zip

Date of Birth (MM / DD / YYYY)

/

/

X _____________________________________________
Date
/
/

(MM / DD / YYYY)

Authorized Messenger must sign application and show photo ID
in the presence of the County Clerk or County Clerk designee.

“I do hereby certify that I will deliver the Mail-In Ballot directly to
the voter and no other person, under penalty of law.”
Signature of Messenger
Date (MM / DD / YYYY)

X

State

/

/

OFFICE USE ONLY
Voter Reg # ____________________________
Muni Code #_______ Party _______________
Ward __________ District ________________

NJ Division of Elections - 08/18

Printer’s Fee: $241.92
Pub. Date: March 15, 2019

Order No. 0000109413-01

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