the election e ..‘ for which an absentee status is sought k. .1 i. Religious grounds IrtEQVEST AN ABSEfiltrxi BALLOT FOR pa-FOLLOWING ION(S): Lj PRIMARY I" (GENERAL SPECIAL AU:Elections conducted in the calendar year SIGNATUR • VOTER or /a 17r -(3 DATE I swear or affirm to the sel , under pena

to the date of the election for which an absentee status is sought Q i. Religious grounds II.REQUEST AN ABSEnBALLOT FOR 111FIFOLLOWING 'TION(S): Lj PRIMARY GENERAL L_ISPECIAL _ ALL Elections conducted In the calendar year SIGNATURE OF VOTER or Voter Representative DATE I swear or affirm to the self