Town Clerk’s Office

21 Academy Avenue

Atkinson NH 03811

603-362-4920

Fax 603-362-5305

APPLICATION FOR OFFICIAL TOWN ABSENTEE BALLOT

TO THE TOWN CLERK OF ATKINSON NH:

I, _________________________________ hereby, apply for an official absentee voting ballot. I am a duly qualified voter, and entitled to vote in the Town of Atkinson NH.

My address is: _________________________________________________________________

Street and Number

_________________________________________________________________

Town and State

Mail absentee ballot to: _________________________________________________________

Street & Number / or Post Office Box

_________________________________________________________

Town and State

Signature: ___________________________________________Date _____________________

Telephone: __________________________________________