2014 New Hampshire Revised Statutes
Title LXIII - ELECTIONS
Chapter 657 - ABSENTEE VOTING
Section 657:4 - Forms.

    657:4 Forms. –
    I. Prior to any state election, the secretary of state shall prepare the appropriate application forms for absentee ballots worded in substantially the following form. The secretary of state shall insert the names of all parties qualified as set forth in RSA 652:11 in the list of parties on the application form. The secretary of state shall prepare the application forms in such quantity as he or she deems necessary:
    I hereby declare that (check one):
    ___ I am a duly qualified voter who is currently registered to vote in this town/ward.
    ___ I am absent from the town/city where I am domiciled and will be until after the next election, or I am unable to register in person due to a disability, and request that the forms necessary for absentee voter registration be sent to me with the absentee ballot.
    I will be entitled to vote by absentee ballot because (check one):
    ___ I plan to be absent on the day of the election from the city, town, or unincorporated place where I am domiciled.
    ___ I am requesting a ballot for the presidential primary election and I may be absent on the day of the election from the city, town, or unincorporated place where I am domiciled, but the date of the election has not been announced. I understand that I may only make such a request 14 days after the filing period for candidates has closed, and that if I will not be absent on the date of the election I am not eligible to vote by absentee ballot.
    ___ I cannot appear in public on election day because of observance of a religious commitment.
    ___ I am unable to vote in person due to a disability.
    ___ I cannot appear at any time during polling hours at my polling place because an employment obligation requires me to remain physically at work or to be in transit to or from work from the time the polls open until after the time the polls close.
    Any person who votes or attempts to vote using an absentee ballot who is not entitled to vote by absentee ballot shall be guilty of a misdemeanor. RSA 657:24.
    I am requesting an official absentee ballot for the following election (check one):
    ___ Presidential Primary to be held on __________
    (MM/DD/YYYY)
    (The date may appear as blank when the date is not known.)
    ___ State Primary to be held on __________
    (MM/DD/YYYY)
    ___ General Election
    For primary elections, I am a member of or I am now declaring my affiliation with the (check one):
    ___ Republican Party
    ___ Democratic Party
    and am requesting a ballot for that party's primary.
    Please print:
    Applicant's Name:
    __________________________________________________
    (Last) (First) (Middle) (Sr., Jr., II., III)
    Applicant's Voting Domicile (home address):
    __________________________________________________
    (Street Number) (Street Name) (Apt/Unit) (City/Town) (Ward) (Zip Code)
    Mail the ballot to me at this address (if different than the home address):
    ______________________________
    (Street Number) (Street Name) (Apt/Unit) (City/Town) (Ward) (Zip Code)
    Applicant's Signature: __________
    The applicant must sign this form to receive an absentee ballot.
    Date Signed: __________
    (MM/DD/YYYY)
    II. Any person that publishes, mails, or distributes in any manner any written communication that contains a form or post card which a reasonable person would consider as intended to be used by the recipient of the communication to submit a request for an absentee ballot shall attach a copy of the form prepared by the secretary of state pursuant to paragraph I of this section to the communication or include in the communication a complete facsimile of the form prepared by the secretary of state pursuant to paragraph I of this section. Any person that violates this paragraph shall be subject to a civil penalty not to exceed $1,000, to be imposed in the manner set forth in RSA 659:34, III-V.
    III. The federal official post card form shall constitute the form made available by the secretary of state pursuant to RSA 654:20 for absentee ballot applications by UOCAVA voters.

Source. 1979, 436:1; 308:3, 4. 1988, 73:3. 2006, 136:5. 2007, 212:2, eff. June 25, 2007. 2009, 288:2, eff. Sept. 27, 2009. 2010, 317:20, eff. July 18, 2010.