Application form.

To the Town Clerk of the Town of ...., Connecticut I, the undersigned, declare under penalty of false statement in absentee balloting that the following statements are true: 1. I am a citizen of the United States. 2. I have not forfeited my electoral privileges because of conviction of a disfranchising crime. 3. I was born on ...., and on the day of the next presidential election, I shall be at least 18 years of age. 4. FORMER RESIDENT. I am a former resident of the above town, to which I am making this application, and resided at .... Street therein. I moved from such town to my present town and state of residence on the .... day of ...., 20.., being within thirty days before the date of the next presidential election, and for that reason I cannot register to vote in said presidential election in my present town and state of residence. I am now a bona fide resident of the Town of ...., in the state of ...., now residing at .... Street therein. 5. I hereby apply for a “presidential ballot” for the election to be held on ...., 20... I have not voted and will not vote otherwise than by this ballot at that election. I am not eligible to vote for electors of President and Vice-President in any other state. 6. The said ballot is to be given to me personally or mailed to me at .... (bona fide mailing address) Dated at ...., this .... day of .... 20... .... (Signature of applicant) (b) The application for an overseas ballot shall be the federal application permitted under section 9-153a or a form signed by the applicant under penalty of false statement in absentee balloting which shall provide substantially as follows: To the Town Clerk of the Town of ...., Connecticut I, the undersigned, declare under penalty of false statement in absentee balloting that the following statements are true: 1. I am a citizen of the United States. 2. I have not forfeited my electoral privileges because of conviction of a disfranchising crime. 3. I was born on ...., and on the day of the next federal election, I shall be at least eighteen years of age. 4. I was a resident of the above town, to which I am making this application, and resided at no. .... Street therein. I moved from such town to my present residence on the .... day of ...., 20... I now reside in ...., at no. .... Street therein. 5. I have a valid passport or card of identity and registration issued under the authority of the Secretary of State of the United States or alternate form of identification.