Free Emergency Absentee Ballot Packet - Pennsylvania

FIRST JUDICIAL DISTRICT OF PENNSYLVANIA
Procedure to follow in the filing of EMERGENCY APPLICATIONS FOR ABSENTEE BALLOT For Primary Election 2009: May 19, 2009 As required by Act 137 of 2006 (25 P.S. §3146.2a), electors who become physically disabled or ill, or due to business reasons are absent from Philadelphia after 5:00 PM Friday, May 15, 2009 and until 8:00 PM on Election Day ­ May 19, 2009 may request an Absentee Ballot if the elector or the elector's Authorized Representative completes and files with the Court of Common Pleas an "Emergency Application" (or a letter or other signed document which includes the same information as is provided in the Emergency Application) as follows: 1) Only the elector or his/her Authorized Representative can file the Emergency Application and attend the hearing scheduled after the Emergency Application is filed. 2) Other than on the day of the Primary Election, May 19, 2009, Emergency Applications can only be filed during court hours: between 9:00 AM and 5:00 PM. 3) Monday, May 18, 2009. The elector or the elector's Authorized Representative may file an Emergency Application for Absentee Ballot from 9:00 AM to 5:00 PM in Room 280, City Hall. No filing fee shall be paid. The Prothonotary shall assign a Court Term and Number and return the Application and Order to the filer who will bring it to Civil Administration in Room 296 City Hall. Civil Administration shall: schedule a hearing, give a copy of the Application and Scheduling Order to the elector or elector's Authorized Representative, and fax a copy of the Application and Scheduling Order to the Election Voter Registration Clerk (Fax: 686-3398; Phone 686-3943). The Election Voter Registration Clerk will determine whether the elector is otherwise qualified to vote, and if so, will print and bring the Absentee Ballot to the scheduled hearing. Election Staff personnel will be present at the hearing to answer any questions. After the hearing, the judge will issue the Final Order. If the Application is granted, the judge will give the elector or the elector's Authorized Representative the absentee ballot. 4) Tuesday, May 19, 2009. The elector or the elector's Authorized Representative may file an Emergency Application for Absentee Ballot from 9:00 AM to 8:00 PM in Room 280, City Hall. No fee shall be paid. The Prothonotary shall assign a Court Term and Number, schedule a hearing for Central Election Court, Room 676 City Hall, give a copy of the Application and Scheduling Order to the elector or elector's Authorized Representative and fax a copy of the Application and Scheduling Order to the Election Voter Registration Clerk (Fax: 686-3398; Phone 686-3943). The Election Voter Registration Clerk will determine whether the elector is otherwise qualified to vote, and if so, will print and bring the Absentee Ballot to the scheduled hearing. Election Staff personnel will be present at the hearing to answer any questions. After the hearing, the judge will issue the Final Order. If the Application is granted, the judge will give the Elector or Authorized Representative the absentee ballot. 5) The required forms are available from: the County Board of Elections, Room 142 City Hall; the Prothonotary, Room 280 City Hall; the First Judicial District's Civil Administration, Room 296 City Hall, and the Court's website: http://courts.phila.gov/forms.html. Date: April 27, 2009 Hon. Pamela Pryor Dembe President Judge, Court of Common Pleas

FIRST JUDICIAL DISTRICT OF PENNSYLVANIA IN THE COURT OF COMMON PLEAS OF PHILADELPHIA COUNTY Emergency Application for Absentee Ballot of : : _________________________________________ Elector : No. MAY TERM, 2009

SCHEDULING O R D E R A Hearing on the Emergency Application for Absentee Ballot is scheduled for May ____, 2009, at ____________ AM/PM in Courtroom _____________ City Hall, Phila., PA.

FOR THE COURT: Date: _________ ______________________________

FINAL O R D E R AND NOW, this day of May, 2009, upon consideration of the Emergency Application for Absentee Ballot filed by, or on behalf of, the above Elector, and after a hearing thereon, IT IS HEREBY ORDERED, ADJUDGED and DECREED that: The Emergency Application for Absentee Ballot is denied.

The Court is satisfied that the above named elector is otherwise qualified to vote, and that the
elector became physically disabled or ill, or was called away on business, after 5:00 PM on May 15, 2009, and an Absentee Ballot is issued to:

The Elector The Elector's authorized representative:
____________________________________________________________ who must comply with, sign and file the attached Certification of Authorized Representative. BY THE COURT: _________________________ J.

(For Erne

EMERGENCY APPLICATION FOR ABSENTEE BALLOT
encies That Occur After 5:00 P.M. on the Frida Before the Prima

or Election)

1, -------,""',...,.,"""~"""'...,.,,_;;_o;""""""""""""..,,___----- declare that I am a voter (PLEASE PRINT NAME AS REGISTERED)
of County, Pennsylvania, and that I am a qualified and registered elector at my home address which is
(STREET ADDRESS OR RURAL ROUTE)

(pOST OFFICE ANDJOR ZIP CODE)

in the
----

Ward,

District, of the
(CfrY/lJOROtrOViN.TOWNSHIP)

that I have resided in this voting

district since

and that I am entitled to vote therein Uris primary or election.
_ My date of birth is .


IMy occupation is

I (If employee of the Commonwealth or Federal Government qualified to vote without street address, check here. CJ)
I MAIL BALLOT TO ME AT THE FOLLOWING ADDRESS, IF' APPLICABLE:

i---------------------------

f-------t-------------------------------------
ABSENCE FROM TIlE MUNICIPALITY
I expect to be absent from the municipality of my residence on the day of the election/primary because of duties, occupation or business, which fact was not and could not be known to me on or before 5:00 P.M. on the Friday prior to the election
(DATE OF SIGNING) (SIGNATURE OF VOTER)

Sworn and subscribed before me this

day of

20

(SrAtE 1Il LE Of OFFICE, NotARY pOBLIc, Erc AFFIX SEAL)
1 - - - - - - - - - - - - + - - - - - - - - - - - - - - - , - - - - - - - - - - - - - - - - - - -----------------------~

ILLNESS OR PHYSICAL DISABILITY
I expect to be unable to attend my proper polling place on the day of the election/primary because of illness or physical disability. The nature of which appears below:
(IN sHkt bIMBlE! ry ok ILLNESS: HERE)
(DATE OF SIGNING) (SIGNATORE OF VOTER)

I hereby attest that the physical disability or illness of above elector occurred at a time when he was unable to apply for an absentee ballot, on or before 5:00 P.M on the Friday prior to the election.
(SIGNATURE OF PHYSICIAN)

Sworn and subscribed before me this _ _ day of

20_

The following to be completed if applicant is unable to sign because of illness or physical disability. I hereby state that I am unable 10 sign my application for an absentee ballot without assistance because I am unable to write by reason of my illness or physical disability. I have made, or have received assistance in making my mark in lieu of my signature.
(DATE)
(MARK)

(COMPLETE ADDRESS IF WITNESS)

(SIGNATURE OF WITNESS)

I

NOTE: Electors requiring assistance in voting must procure Special Form from the county Board of Elections to ~ transmit with this application.

WARNING - IF YOU ARE ABLE TO VOTE IN PERSON ON ELECTION DAY, YOU MUST GO TO YOUR POLLING
'---------__ PLACE, VOID YOUR ABSENTEE BALLOT AND VOTE THERE.

Designation of Authorized Representative
to Assist Emergency Absentee Ballot Applicant

Court of Common Pleas of ----------:~----(Insert Name ofCounty)

I hereby designate

_ _~
(Insert Name ofAuthorized Representative)

ro serve as my

agent for obtaining an emergency absentee ballot for my use only and to return the ballot after I have completed it and sealed it in the required envelope to the Board of Elections of _ _ _ _ _ _ _ County. I understand that my completed ballot must be returned to the Board of Elections no later than 8:00 P.M. on the day of the primary or election. I am qualified under Pennsylvania law to vote by emergency absentee ballot because of illness or physical disability that occurred after 5:00 P.M. on the Friday before the primary or election or because I will be absent from my municipality on the day of the primary or election because of my business, duties or occupation, which fact was not and could not reasonably be known prior to 5:00 P.M, on the Friday before the primary or election.

(Address of Voter)

(Voter's Signature)

Certification of Authorized Representative
I hereby agree to serve as the authorized representative for
(Name of Voter)

_

for purposes of obtaining an emergency absentee ballot for the above voter only and to return the ballot, after it has been completed by the voter and sealed in the required envelope to the County Board of Elections. I certify that! am not acting as the authorized representative during t-his election for a..-1Y person who does not live in the same household as the above-named voter.

(Signature ofAuthorized Representative)

Name and Address of Authorized Representative (Please Print):

(Name ofAuthorized Representative)

(Address ofAuthorizedRepresentative)

25 P.S. § 3146.2a (2008) § 3146.2a. Date of application for absentee ballot (a) Except as provided in subsections (a.1) and (a.2), applications for absentee ballots shall be received in the office of the county board of elections not earlier than fifty (50) days before the primary or election and not later than five o'clock P.M. of the first Tuesday prior to the day of any primary or election. (a.1) Except as provided in subsection (a.2), in the event any elector otherwise qualified who is so physically disabled or ill on or before the first Tuesday prior to any primary or election that he is unable to file his application or who becomes physically disabled or ill after the first Tuesday prior to any primary or election and is unable to appear at his polling place or any elector otherwise qualified who because of the conduct of his business, duties or occupation will necessarily be absent from the municipality of his residence on the day of the primary or election, which fact was not and could not reasonably be known to said elector on or before the first Tuesday prior to any primary or election, the elector shall be entitled to an absentee ballot at any time prior to five o'clock P.M. on the first Friday preceding any primary or election upon execution of an Emergency Application in such form prescribed by the Secretary of the Commonwealth. (a.2) In the event any elector otherwise qualified who becomes so physically disabled or ill between five o'clock P.M. on the first Friday preceding any primary or election and eight o'clock P.M. on the day of any primary or election that he is unable to appear at his polling place or any elector otherwise qualified who because of the conduct of his business, duties or occupation will necessarily be absent from the municipality of his residence on the day of the primary or election, which fact was not and could not reasonably be known to said elector prior to five o'clock P.M. on the first Friday preceding any primary or election, the elector shall be entitled to an absentee ballot if the elector completes and files with the court of common pleas in the county in which the elector is qualified to vote an Emergency Application or a letter or other signed document, which includes the same information as is provided on the Emergency Application. Upon a determination that the elector is a qualified absentee elector under section 1301, the judge shall issue an absentee ballot to the elector. If the elector is unable to appear in court to receive the ballot, the judge shall give the elector's absentee ballot to an authorized representative of the elector who is designated in writing by the elector. The authorized representative shall deliver the absentee ballot to the elector and return the completed absentee ballot, sealed in the official absentee ballot envelopes, to the county board of elections, who shall distribute the ballot, unopened, to the absentee voter's election district. If the elector is unable to appear in court or unable to obtain assistance from an authorized representative, the judge shall direct a deputy sheriff of the county to deliver the absentee ballot to the elector if the elector is at a physical location within the county and return the completed absentee ballot, sealed in the official absentee ballot envelopes, to the county board of elections, who shall distribute the ballots, unopened, to the absentee voter's respective election district. If there is no authorized representative and a deputy sheriff is unavailable to deliver an absentee ballot under this section, the judge may direct a constable to make such delivery in accordance with the provisions of this section. In the case of an elector who requires assistance in marking the elector's ballot, the elector shall designate in writing the person who will assist in marking the ballot. Such person shall be otherwise eligible

to provide assistance to electors eligible for assistance, and such person shall declare in writing that assistance was rendered. Any person other than the designee who shall render assistance in marking a ballot or any person rendering assistance who shall fail to execute a declaration shall be guilty of a violation of this act. No absentee ballot under this subsection shall be counted which is received in the office of the county board of elections later than eight o'clock P.M. on the day of the primary or election. (b) In the case of an elector whose application for an absentee ballot is received by the office of the county board of elections earlier than fifty (50) days before the primary or election, the application shall be held and processed upon commencement of the fifty-day period. (c) In the case of an elector who is physically disabled or ill on or before the first Tuesday prior to a primary or election or becomes physically disabled or ill after the first Tuesday prior to a primary or election, such Emergency Application, letter or other signed document shall contain a supporting affidavit from his attending physician stating that due to physical disability or illness said elector was unable to apply for an absentee ballot on or before the first Tuesday prior to the primary or election or became physically disabled or ill after that period. (d) In the case of an elector who is necessarily absent because of the conduct of his business, duties or occupation under the unforeseen circumstances specified in subsections (a.1) and (a.2), such Emergency Application, letter or other signed document shall contain a supporting affidavit from such elector stating that because of the conduct of his business, duties or occupation said elector will necessarily be absent from the municipality of his residence on the day of the primary or election which fact was not and could not reasonably be known to said elector on or before the first Tuesday prior to the primary or election.