The Indiana Republican Party
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You MUST use the PRINT button at the bottom of this form to generate and print the Absentee Ballot Application with your information. Using the print function from the File menu WILL NOT print off a properly formatted Application Form. If you need assistance, call 1-877-648-2422. Sign and mail your printed form to:

Indiana Election Division
302 West Washington Street, Room E204
Indianapolis, Indiana 46204-2743
Absentee Ballot Applications must be received between August 6th and no later than October 27th 2008.
Indiana Application for Absentee Ballot
Election Date (mm/dd/yyyy): / /
Voter ID (see instruction A):
Email:
Birthdate (mm/dd/yyyy): / /
Day Phone (10 digits, no spaces):
Evening Phone 10 digits, no spaces):
Applicant Name
First Middle or Initial Last Suffix
Registration Address
Street City / Town State Zip
Mailing Address (if different from registration address)
Check here if same as registration address
Street City / Town State Zip
Primary Election Only
Ballots (see instruction B):
Absentee Voting Method
Choose Method:
Due Date (mm/dd/yyyy) / / (at midnight)
I have a specific, reasonable expectation of being absent from the county on election day during the entire 12 hours that the polls are open.
I am scheduled to work at my regular place of employment during the entire 12 hours that the polls are open.
I am a voter with disabilities. NOTE: If you are unable to mark the ballot or sign the envelope, you must vote before a traveling board or in the Clerk's office.
I will be confined to my residence, a health care facility, or a hospital due to illness or injury during the entire 12 hours that the polls are open.
I am a voter at least 65 years of age.
I will be caring for an individual confined to a private residence due to illness or injury during the entire 12 hours that the polls are open.
I will have official election duties outside of my voting precinct.
I am unable to vote at the polls in person due to observance of a religious discipline or religious holiday during the entire 12 hours the polls are open.
I am a voter eligible to vote under the "fail-sage" procedures in IC 3-10-11 or 3-10-12.
I am an address confidentiality program participant in the program administered by the Indiana Attorney General under IC 5-26.5-1-6.
Information of Individual Assisting Absentee Ballot Applicant
Name Day Phone
(10 digits, no spaces)		 Evening Phone
(10 digits, no spaces)		 Date of Assistance
(mm/dd/yyyy)
/ /
Residence Street City / Town State Zip
Check here if same as residence
Mailing Street City / Town State Zip

Instructions:

A. Voter ID:
Indiana issued driver's license number, or if voter does not possess driver's license, provide last 4 digits of social security number. Back to Voter ID

B. Primary Election Ballots:
In Indiana, you must request a major political party ballot to vote in the primary election. However, you may vote for school board offices or on referenda held at the same time as the primary without voting a political party ballot. Back to Primary Election Ballots