Absentee Ballot Request

I, ______________________________________, hereby certify that I am or will be an Eligible

(Print Name)

Voter of the Absentee Shawnee Tribe on or before June 18, 2022  I cannot physically

be present to cast my Vote at the  June 18, 2022  Annual Election, therefore, I am requesting an Absentee Ballot be mailed to me at the following address.

Name (please print): ___________________________________________________________

    (first)            (middle)            (maiden)                                                                (last)

Address:____________________________ City: _______________St: _______Zip:________

CDIB#:______________________________       Date of Birth: ______________________

Signature: ____________________________           Date:______________________________

     All REQUESTS must be returned to the Election Commission by the deadline date of

Absentee Shawnee Election Commission

P.O. Box 741

Tecumseh, OK  74873

                                                    Phone: 405.275.4030 ext. 6271

                                                Toll free number 800.256.3341 ext. 6271

                        Election Commission Office located in the Tribal Court Building

             All eligible voters are entitled to vote either at the Polls or by Absentee Ballot.

This form may be duplicated for your convenience.

______________________________________________________________________________          ELECTION COMMISSION USE ONLY

Received: _____________________ Approved:____________________ Disapproved: _______________

If Disapproved (reason): _________________________________________________________________

Denial Letter Mailed:___________________________ Ballot Mailed:_____________________________

_______________________________________                                       Election Commission/Representative