State of _________ | ||
County (City) of _________ | ||
I, _________(print applicant's name), declare that I am a resident and registered voter of _________County, Missouri, and am permanently disabled. I hereby request that my name be placed on the election authority's list of voters qualified to participate as absentee voters pursuant to section 115.284, and that I be delivered an absentee ballot application for each election in which I am eligible to vote. | ||
__________________ | ||
Signature of Voter | ||
_________ | ||
_________ | ||
Voter's Address |
§ 115.284, RSMo