Absentee Ballot Request

PLEASE fill out EACH BLANK completely and return by the Deadline.
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
May 29, 2022
Mail to:
Absentee Shawnee Election Commission
P.O. Box 741
Tecumseh, OK  74873
Fax to:
Fax # 405.273.1337 (Do not fax to any other fax #)
                                                    Phone: 405.275.4030 ext. 6271
                                                Toll free number 800.256.3341 ext. 6271
Deliver in Person to:
                        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