2017 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:

Absence (Excluding Absence Due to Residence Outside the United States), 
Religious Observance, and Disability: 
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 of an employment obligation. For the purposes of this application, 
 the term "employment  shall include the care of children and infirm adults, 
 with or without compensation. 
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 Phone Number (optional): _________________________ 
Applicant's Email Address (optional): __________________________ 
Applicant's Signature: __________________ 
Date Signed: __________________ 
(MM/DD/YYYY) 

       The applicant must sign this form to receive an absentee ballot. The signature on this form must match the signature on the affidavit envelope in which the absentee ballot is returned, or the ballot may be rejected. Any person who assists a voter with a disability in executing this form shall make a statement acknowledging the assistance on the application form to assist the moderator when comparing signatures on election day.
    II. (a) Any person, other than the city or town clerk or the secretary of state, 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 identify who is publishing, mailing, or distributing the communication, and 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.
       (b) Any person that publishes, mails, or distributes forms as described in subparagraph (a) as part of any communication that is made for the purpose of promoting the success or defeat of a candidate or candidates or measure or measures, as defined in RSA 664:2, shall be identified in the same manner as political advertising under RSA 664:14.
       (c) 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, 308:3, 4; 436:1. 1988, 73:3. 2006, 136:5. 2007, 212:2. 2009, 288:2. 2010, 317:20, eff. July 18, 2010. 2016, 90:1, eff. Jan. 1, 2017; 130:2, eff. May 27, 2016. 2017, 49:1, eff. July 11, 2017; 216:6, eff. July 11, 2017 at 12:01 a.m.