General Election – November 4, 2014


Deadline to apply for an Early Voter Ballot to be mailed to a specific address is Wednesday, Oct. 29, 2014 at 4:00 P.M.


Deadline for Early Voting in person at the County Clerk’s office is Monday, Nov. 3, 2014.


Deadline for agent to pickup Early Voting Ballot is Nov. 4, 2014 at 7:00 P.M.




Date:  ____________________


I, the undersigned, declare that I am a registered voter in Nebraska.


I am registered at the following address:


_________________________________________________________________________, in Stanton County.


My election/voting precinct is: _______________________.  Check this box ¨ if your election/voting precinct is not know.


I am a registered voter in the State of Nebraska, affiliated with the following party:

Democratic  ¨          Libertarian  ¨          Republican  ¨  or, I registered:  Nonpartisan  ¨  (unaffiliated with any party)

**Nonpartisans – Please read notice at the bottom of this application**


I am requesting early voting ballots for the following election: 

Primary  ¨     General  ¨     Special  ¨  to be held on ______________________, 2014.


¨  I request to vote in the Election Office today as the Early Voting Polling Place.


¨  I request that ballots be mailed to me. (or to the person I am acting as agent for), at the following address:


Address:  _____________________________________________________________


City, State, Zip:  ________________________________________________________


¨  I request to take the ballots with me, (or to the person I am acting as agent for).


To confirm any information prior to sending the ballots, the Election Office may reach me at: 


Phone:  _____________________   Email:  ______________________________________________


Voter’s Printed Name:  ________________________  Voter’s Signature:  _____________________________


If applying for another voter:  Agent’s Signature:  ________________________  Relationship:  ____________


The penalty for election falsification is imprisonment for up to five years, or a fine not to exceed $10,000.00 or both.


**For Nonpartisans ONLY:  If you wish to vote in this primary election for U.S. Senator and/or U.S. House of Representative, you may request a partisan ballot as stated in§32-912(2) from one of the political parties by checking the appropriate box.

(For the 2014 Primary, the Democratic and libertarian parties opened their Primary election to nonpartisans, so their ballot will contain federal, state and county offices.  The Republican ballot will contain only federal office candidates.)

Democratic  ¨          Libertarian  ¨         Republican  ¨


Election Office Use Only

     Application Number: ____________  Date Received: ________________  Date Sent:  ________________

      Voter ID Number:  _____________  Ballot Assigned: _______________  Staff Initials:  _____________


Return form to:  Stanton Co Clerk, 804 Ivy St, PO Box 347, Stanton NE 68779