EARLY VOTER’S BALLOT REQUEST FORM

I, _________________________________, hereby request that an early voter’s ballot be mailed

to me for the GENERAL ELECTION occurring on NOVEMBER 4, 2008. I am a registered

voter residing at ______________________________________________________________

(address, city)

in Red Willow County.

My party affiliation is: _____ Democrat _____ Republican _____ Nebraska

_____ Green _____ Libertarian _____ Nonpartisan

My phone number is: _______________________.

The ballot should be mailed to me at ___________________________________________

___________________________________________

____________________________________

(Signature of Voter)

__________________________

(Date)

NOTE: Please return this form to: Pauletta Gerver

Red Willow County Clerk

502 Norris Ave.

McCook, NE 69001

If you have any questions, please call (308) 345-1552.