# Federal Write-in Absentee Ballot (FWAB)
Instructions for Voter’s Declaration /AffirmationStandard Form 186 (Rev. 03-2013) 

### The gray numbers and instructions below correspond to the gray numbered
boxes on the face of the form.

1 

### In most States, you must have registered and requested an absentee ballot from your voting jurisdiction to use this form. If you have not done this, you cannot use this form unless your State allows voter registration via the FWAB. If your State does not allow you to register to vote using this form and you have not already submitted a Federal Post Card Application or registered/requested an absentee ballot by other means, your FWAB will not be counted.

2 

### The classification you choose will determine in which election(s) you will be allowed to vote. Choose the one that best represents your current situation.

3 

### The information you enter for your name should match the information you used to register to vote. The local election official who receives this form will match this to your voter registration
information.

4 

### While most States allow you to enter either your driver’s license number or the last 4 digits of your Social Security Number, some will invalidate this form without your full SSN. Check your State’s pages in the Voting Assistance Guide on FVAP.gov to see if your State requires the full SSN.

Also, many States ask that you provide your race or ethnic group in order to demonstrate that they are complying with the Voting Rights Act and the National Voter Registration Act

.

5 

### If there are questions about your form, local election officials will use this information to contact you. An email address is the simplest and fastest way for them to do so. Your voting materials will be sent to the email address(es) that you provide here if you request it and your State allows it. Include an alternate phone number in Box 9 if necessary.

6 

### If you want to vote in primary elections, most States require you to specify a political party.

7 

### This determines the jurisdiction where you vote. For military voters the voting address is your legal U.S. residence. For overseas citizens this is usually the U.S. address where you last lived. You do not need to have any current physical ties to this address. Do not use a post office box number. If the area has no street names, enter the route number and box number. The address you enter here must match the address you used when you requested an
absentee ballot.

8 

### Enter the address where you want voting materials to be sent to you. Voting materials will be sent to this address unless you enter a forwarding address in Box 9.

9 

### Enter anything here that would help ensure that your ballot is accepted. Check your State’s pages in the Voting Assistance Guide on FVAP.gov for anything your State may specifically require
here.

Affirmation. Read this carefully. It is what you are agreeing to under oath and penalty of perjury by filling out and sending in this form. Some States require that your form be witnessed. Check your State’s pages in the Voting Assistance Guide on FVAP.gov for your State’s requirements. 

# Federal Write-in Absentee Ballot

To vote, write in either a candidate’s name or a political party for each office. Your State may allow you to vote in State and local elections in the Addendum section of this ballot. If you submit the FWAB and later receive your State ballot you should make every reasonable effort to inform your local election office and return your State ballot.

Some States allow you to send your Federal Write-in Absentee Ballot electronically after printing, signing and scanning. Check your State’s pages in the Voting Assistance Guide on FVAP.gov to see if your State allows this.

To return by mail, fold the ballot. Put it in a blank envelope, seal the envelope, and mark it “Security Envelope.” This security envelope keeps your vote private.

Put the security envelope and the Declaration / Affirmation form into a larger envelope together. Seal the larger envelope.

To send your ballot:

• For non-U.S. mailing, put the correct amount of local postage in

the top right corner on the front of the large envelope.

• In the upper left corner, enter your current complete military or

overseas mailing address.

• Under “To,” enter the name and mailing address of the local

election official to whom you are sending the packet. It must be the same local election office where you sent your request for an absentee ballot.



# Privacy Act Statement

Authority: The authority to collect your personal information on this form comes from 42 USC 1973ff, “Uniformed and Overseas Citizens Absentee Voting Act (UOCAVA).”

Principal Purpose: This form serves as a Federal Write-in Absentee Ballot for elections for Federal office or other elections provided by State law or special provisions for all persons covered by UOCAVA.

Disclosure: Your disclosure of personal information is voluntary. However, failure to provide the requested information may result in the Federal Write-in Absentee Ballot not being recognized and therefore not counted. For any questions about this form, consult the Voting Assistance Guide available in hard copy or on FVAP.gov or your Voting Assistance Officer.



# Agency Disclosure Statement

The public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management Division, 4800 Mark Center Drive, East Tower, Suite 02G09, Alexandria, VA 22350-3100. [OMB CONTROL #]. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with acollection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ADDRESS ABOVE.Signature
You must sig n and send in. 

# Federal Write-in Absentee Ballot (FWAB) Voter’s Declaration/Affirmation

County Previous name (if applicable) 

## Qualifications & Voter Registration

M any States require that you be registered and request an absentee ballot before using this form. If you answer No, you can do this via the Federal Post Card Application on FVAP.gov , or in a few States, by marking the box below. Check your State’s pages in the Voting Assistance Guide on FVAP.gov to see if your State allows registration via this form. Have you already registered and requested an absentee ballot?

I also want to register to vote and/or request an absentee ballot for all elections in which I am eligible to vote.



## Identification
Some States require your full SSN. Check your State’s pages in the Voting Assistance Guide

on FVAP.gov

.



## Contact information
Include international prefixes. No DSN number. – – Last name Suffix

Apt. # 

## My legal name

City/Town/Village Street Address (not P.O. Box) 

## My voting residence address

Usually your last U.S. residence or your legal U.S. residence. See instructions.


## Where to send my voting materials
This is your current mailing address and should be different from above. If required, place a forwarding address in Box 9.



## Additional requirements from your State
Such as: mail forwarding address, additional phone, or other State required information. See your State’s pages in the Voting Assistance Guide on FVAP.gov

. Please print in black ink.



## Classification
Make only 1 selection. I am an activated National Guard member on State orders.

/ /

/ /

Standard Form 186 (Rev. 03-2013), OMB No. XXXX-XXXX Witness signature / date if required by your State.

See Voting Assistance Guide on FVAP.gov I am a member of the Uniformed Services or Merchant Marine on active duty OR I am an eligible spouse or dependent.

First name Middle name Yes No

Sex Birth date

Social Security Number

OR State Driver’s License or I.D.

Telephone

Fax

State Zip Code

Today’s date Email

Alternate Email 1

5

7 4 3

9 2

8

This information is for official use only. Any unauthorized release may be punishable by law. – To vote in primary elections, your State may require you to specify a political party. 

## Political party 6

Signature

Date Race See Instructions I am a U.S. citizen residing outside the U.S., and my return is not certain. I am a U.S. citizen residing outside the U.S., and I intend to return.

M F I am a U.S. citizen and have never resided in the United States.



## Affirmation (REQUIRED): I swear or affirm, under penalty of perjury, that: M M

M M D D D D

Y Y Y Y Y Y Y Y



### •

The information on this form is true, accurate, and complete to the best of my knowledge. I understand that a material misstatement of fact in completion of this document may constitute grounds for conviction of perjury. •I am a U.S. citizen, at least 18 years of age (or will be by the day of the election), eligible to vote in the requested jurisdiction, and •I am not disqualified to vote due to having been convicted of a felony or other disqualifying offense, nor have I been adjudicated mentally incompetent; or if so, my voting rights have been reinstated; and •I am not registering, requesting a ballot, or voting in any other jurisdiction in the U.S., except the jurisdiction cited in this voting form. •In voting, I have marked and sealed this ballot in private and have not allowed any person to observe the marking of this ballot, except for those authorized to assist voters under State or Federal law. For any questions about this form, consult the Voting Assistance Guide available in hard copy

or on FVAP.gov or your Voting Assistance Officer.

# Official Federal Write-in Absentee Ballot

President/Vice President:

U.S. Senator*:

* Legal residents of the District of Columbia may vote only for President/V ice President and Delegate.

** Legal residents of American Samoa, Guam, Puerto Rico and the U.S. Virgin Islands may vote only for Delegate or Resident Commissioner to the Congress.



# Addendum

Vote by writing the name and/or party affiliation of the candidate for whom you wish to vote. Some States allow the Fed

eral Write-In Absentee Ballot to be used by military and overseas voters in elections other than general elections or for offices other than Federal offices. Consult your State section in the V oting Assistance Guide on FVAP.gov to determine your State’s policy. If you are eligible to use this ballot to vote for offices other than those listed above or for ballot initia

tives, please indicate in the spaces provided below, the office for which you wish to vote (for example: Governor, Attorney General, Mayor, State Senator, etc.). You may also indicate the ballot intiative and your vote for the initiative. U.S. Representative/Delegate**/Resident Commissioner**:

Standard Form 186 (Rev 08-2013) 

# Office / Ballot Initiative Candidate Name, Party Affiliation, or Initiative Vote

# Official Federal Write-in Absentee Ballot (continuation)

Standard Form 186 (Rev 03-2013) 

# Office / Ballot Initiative Candidate Name, Party Affiliation, or Initiative Vote

## From (Your name and current complete military or overseas mailing address)

International airmail postage is required if not mailed in the U.S. Postal Service, APO/FPO system, or diplomatic pouch. U.S. Postage Paid 39 USC 3406



### PAR AVION



## To (Your local election office in the United States. Check your State’s pages in the Voting Assistance Guide on FVAP.gov for contact information. )



## OFFICIAL ABSENTEE BALLOTING MATERIAL – FIRST CLASS MAIL

NO POSTAGE NECESSARY IN THE U.S. MAIL – DMM 703.8.0 

# Ballot Enclosed for __________ Election.

(MM/YY)

# I NSTRUCTIONS TO VOTER
Before you seal this envelope, check that you have done the following:

1) Did you sign your form?

2) Did you put the form into this mailing envelope?

3) Did you put your ballot inside a security envelope?

4) Did you put the security envelope into this mailing envelope?

INSTRUCTIONS TO ELECTION OFFICIALS This is an official Federal Write-in Absentee Ballot (FWAB) authorized by 42 USC 1973 ff-2.

1. Upon receipt of this ballot, examine the voter’s declaration form. If it appears the voter is eligible to vote in your jurisdiction and has applied in a timely fashion for a regular absentee ballot, or this requirement has been waived by appropriate authority, this ballot is valid unless you receive the voter regular absentee ballot in time for it to be counted. This ballot should be handled in the same manner as required by State law for other absentee ballots. If this ballot is to be counted, deposit the voted ballot in the ballot box without examining the voter ’s choice. 2. The oath on this ballot is self-executing and need not be notarized or witnessed, unless required by State law. 3. Unless provided by law, or special provisions have been made, this ballot should not be counted if: a. It was submitted by a member of the Uniformed Services (or eligible dependent) not absent from his or her voting jurisdiction; or b. It was submitted from within the United States (an APO/FPO address is considered outside the U.S.) by a citizen who is neither a Uniformed Services member, member of the Merchant Marine, or a dependent of a Uniformed Services or Merchant Marine member; or c. This voter’s application for a regular absentee ballot was received by you less than 30 days prior to the election, or later than required by State law for receipt of application, whichever is later; or d. You received this voter’s completed regular absentee ballot by the State deadline for receipt of absentee ballots; or e. This ballot was not received by the State deadline for receipt of voted absentee ballots.
Standard Form 186 (Rev 03-2013)