2015 Mississippi Code
Title 23 - ELECTIONS
Chapter 15 - MISSISSIPPI ELECTION CODE
Article 19 - ABSENTEE BALLOTS
A. ABSENTEE BALLOTING PROCEDURES LAW
§ 23-15-627 - Distribution of absentee ballot application by registrar; request for absentee ballot application by certain persons on behalf of an elector; form of application

The registrar shall be responsible for furnishing an absentee ballot application form to any elector authorized to receive an absentee ballot. Except as otherwise provided in Section 23-15-625, absentee ballot applications shall be furnished to a person only upon the oral or written request of the elector who seeks to vote by absentee ballot; however, the parent, child, spouse, sibling, legal guardian, those empowered with a power of attorney for that elector's affairs or agent of the elector, who is designated in writing and witnessed by a resident of this state who shall write his or her physical address on such designation, may orally request an absentee ballot application on behalf of the elector. The written designation shall be valid for one (1) year after the date of the designation. An absentee ballot application must have the seal of the circuit or municipal clerk affixed to it and be initialed by the registrar or his deputy in order to be utilized to obtain an absentee ballot. A reproduction of an absentee ballot application shall not be valid unless it is a reproduction provided by the office of the registrar of the jurisdiction in which the election is being held and which contains the seal and initials required by this section. Such application shall be substantially in the following form:

"OFFICIAL APPLICATION FOR ABSENT ELECTOR'S BALLOT

I, , duly qualified and registered in the Precinct of the County

of , and State of Mississippi, coming within the purview of the definition

'ABSENT ELECTOR' will be absent from the county of my residence on election

day, or unable to vote in person because (check appropriate reason):

( ) (PRESIDENTIAL APPLICANT ONLY:) I am currently a resident of Mississippi

or have moved therefrom within thirty (30) days of the coming presidential

election.

( ) I am an enlisted or commissioned member, male or female, of any

component of the United States Armed Forces and am a citizen of Mississippi,

or spouse or dependent of such member.

( ) I am a member of the Merchant Marine or the American Red Cross and am a

citizen of Mississippi or spouse or dependent of such member.

( ) I am a disabled war veteran who is a patient in any hospital and am a

citizen of Mississippi or spouse or dependent of such veteran.

( ) I am a civilian attached to and serving outside of the United States

with any branch of the Armed Forces or with the Merchant Marine or American

Red Cross, and am a citizen of Mississippi or spouse or dependent of such

civilian.

( ) I am a citizen of Mississippi temporarily residing outside the

territorial limits of the United States and the District of Columbia.

( ) I am a student, teacher or administrator at a college, university,

junior or community college, high, junior high, elementary or grade school,

whose studies or employment at such institution necessitates my absence from

the county of my voting residence or spouse or dependent of such student,

teacher or administrator who maintains a common domicile outside the county of

my voting residence with such student, teacher or administrator.

( ) I will be outside the county on election day.

( ) I have a temporary or permanent physical disability.

( ) I am sixty-five (65) years of age or older.

( ) I am the parent, spouse or dependent of a person with a temporary or

permanent physical disability who is hospitalized outside his county of

residence or more than fifty (50) miles away from his residence, and I will be

with such person on election day.

( ) I am a member of the congressional delegation, or spouse or dependent

of a member of the congressional delegation.

( ) I am required to be at work on election day during the times which the

polls will be open.

I hereby make application for an official ballot, or ballots, to be voted

by me at the election to be held in , on .

Mail 'Absent Elector's Ballot' to me at the following address (if

eligible to vote by mail).

I realize that I can be fined up to Five Thousand Dollars ($5,000.00) and

sentenced up to five (5) years in the Penitentiary for making a false

statement in this application and for selling my vote and violating the

Mississippi Absentee Voter Law. (This sentence is to be in bold print.)

If you are temporarily or permanently disabled, you are not required to

have this application notarized or signed by an official authorized to

administer oaths for absentee balloting. You are required to sign this

application in the proper place and have a person eighteen (18) years of age

or older witness your signature and sign this application in the proper place.

DO NOT SIGN WITHOUT READING. (This sentence is to be in bold print.)

IN WITNESS WHEREOF I have hereunto set my hand and seal this the day

of , 2 .

(Signature of absent elector)

SWORN TO AND SUBSCRIBED before me this the day of , 2 .

(Official authorized to administer oaths for absentee balloting.)

TO BE SIGNED BY WITNESS FOR VOTERS TEMPORARILY OR PERMANENTLY DISABLED:

I HEREBY CERTIFY that this application for an absent elector's ballot was

signed by the above-named disabled elector in my presence and that I am at

least eighteen (18) years of age, this the day of , 2 .

(Signature of witness)

CERTIFICATE OF DELIVERY

I hereby certify that (print name of voter) has requested that I,

(print name of person delivering application), deliver to the voter this

absentee ballot application.

(Signature of person delivering application)

(Address of person delivering application)"