Mark Meadows 2020 Absentee Ballot Request

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North Carolina Absentee Ballot Request Form ‘taco County Board of Elections November 3, 2020 Read instructions before comptating this form, ‘5 West Main Sheet Frankin. NC 26734 Identification = 2 Required feasaamaconne org . 28340-2008 (9) 6283492557 () Voter T st Name ts Vater ion Last Neme Meadows: First Neme Mark Required Miadie Name Randal ‘Sul (4, Se. IV) Former Name iif name has changed) Voter cv cttim MMIII so: ener sc omar txansonc DMV 10 Nana Or Lest four digts of voters Socil Secunty number 1 you nave ined at ths address jess than 30 days, when did you move here? wmmonivyvy) 9/20/2020 ‘sveet 495 McConnell Road |for a relative? | | yee, provige he i | ietrmation | ee | 3 | co Scaly Mountain sae NC zpcee 28775 coun Macon Address Hyougonolrecive mal atthe adsrese, prove yourhamaiingaddss re Maiing Addvess 1023 N Royal Street #302 | Alexandria, VA 22314 1 youteave ts section bank, your ble wi be santo your maiing acres, rf nore Etd, your resiental [Where go you | | shen wore ein | sreet 1023 N Royal Street #302 | | ety Alexandria ‘sue VA ZipCode 22314 | We will use your contact information if we have a question aby = Contact. Wien |S row 826805-c600 fll T ityou are voters near reatve erdian ang are requesting an absentee a jour | Besueeting an, | | same. daca sndraston ote vor eslaomlon) Ass.jeu mat dona Seen Scone Ctecane mame gan DEDTA MEACOWS __pewtonnipte ver Wife lor | g | reired | Aadress 1023 N Royal Street #302 city Alexandria stateV_ zp Code 22314 \ are you Conplata tis section you ae asising a voler who is ln. disabled. or unable to read or wre. Bul are nota near AEA! voter felave olgal guaran. The voter must sign or make ther mark. fa MAT assisted, complete tis tection) | complete this | Assistants fll name dort below). ‘Assistants addreas: form? 7) yee, you aro — fee yt 10 {the voor a pation w a hosp cin. nersing home or r8si home and he voter reeds assistance with some ‘otng ond retrang he bal provide the name and edcess OF he hapa fcity nore ‘Mare ofthe Unformed Serviess or Merchant’ I would ike my bal Marne en active duty or eligible spouse! | ter er cy raat Poanaronee HECEIVER tela are C&S. atzen outside ine United States 1 Mating acaress: ‘Agdress where you ate stationed or living overseas: Di Fex number ‘ear relative of Lagal Guardian (f applicable) sgn and Signature ° Gaehere | Requires rov172020 ote | x [Gontinued [4g] reckityou wous ie o request absentee alot footer sossbeelectonsin 2020 due to your Request onvnued or expected iness cr disbiiy "FRAUDULENTLY GR FALSELY COMPLETING THIS FORM IS A CLASS | FELONY UNDER CHAPTER 163 OF THE NC GENERAL STATUTES

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