1. Each ballot envelope shall bear a statement on which the voter shall state the voter’s name, the voter’s voting address, the voter’s mailing address and the voter’s reason for voting an absentee ballot. If the reason for the voter voting absentee is due to the reasons established under subdivision (6) of subsection 3 of section 115.277, the voter shall state the voter’s identification information provided by the address confidentiality program in lieu of the applicant’s name, voting address, and mailing address. On the form, the voter shall also state under penalties of perjury that the voter is qualified to vote in the election, that the voter has not previously voted and will not vote again in the election, that the voter has personally marked the voter’s ballot in secret or supervised the marking of the voter’s ballot if the voter is unable to mark it, that the ballot has been placed in the ballot envelope and sealed by the voter or under the voter’s supervision if the voter is unable to seal it, and that all information contained in the statement is true. In addition, any person providing assistance to the absentee voter shall include a statement on the envelope identifying the person providing assistance under penalties of perjury. Persons authorized to vote only for federal and statewide officers shall also state their former Missouri residence.

2. The statement for persons voting absentee ballots who are registered voters shall be in substantially the following form:

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State of Missouri
County (City) of _______________
I, ______ (print name), a registered voter of ______ County (City of St. Louis, Kansas City), declare under the penalties of perjury that I am voting in person at a location designated by the local election authority or I expect to be prevented from going to the polls on election day due to (check one):
______ absence on election day from the jurisdiction of the election authority in which I am registered;
______ incapacity or confinement due to illness or physical disability on election day, including caring for a person who is incapacitated or confined due to illness or disability and resides at the same address;
______ religious belief or practice;
______ employment as an election authority, by an election authority at a location other than my polling place, as a first responder, as a health care worker, or as a member of law enforcement;
______ incarceration, although I have retained all the necessary qualifications for voting;
______ certified participation in the address confidentiality program established under sections 589.660 to 589.681 because of safety concerns.
I hereby state under penalties of perjury that I am qualified to vote at this election; I have not voted and will not vote other than by this ballot at this election. I further state that I marked the enclosed ballot in secret or that I am blind, unable to read or write English, or physically incapable of marking the ballot, and the person of my choosing indicated below marked the ballot at my direction; all of the information on this statement is, to the best of my knowledge and belief, true.
__________________ __________________
Signature of Voter Signature of Person
Assisting Voter
(if applicable)
Signed ______ Subscribed and sworn
Signed ______ to before me this
Address of Voter ______day of ______, ______
__________________ __________________
__________________ __________________
Mailing Addresses Signature of notary or
(if different) other officer
authorized to
administer oaths

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Terms Used In Missouri Laws 115.283

  • Affidavit: A written statement of facts confirmed by the oath of the party making it, before a notary or officer having authority to administer oaths.
  • Affirmed: In the practice of the appellate courts, the decree or order is declared valid and will stand as rendered in the lower court.
  • Ballot: the paper ballot, or ballot designed for use with an electronic voting system on which each voter may cast all votes to which he or she is entitled at an election. See Missouri Laws 115.013
  • Conviction: A judgement of guilt against a criminal defendant.
  • County: any county in this state or any city not within a county. See Missouri Laws 115.013
  • District: an area within the state or within a political subdivision of the state from which a person is elected to represent the area on a policy-making body with representatives of other areas in the state or political subdivision. See Missouri Laws 115.013
  • following: when used by way of reference to any section of the statutes, mean the section next preceding or next following that in which the reference is made, unless some other section is expressly designated in the reference. See Missouri Laws 1.020
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • person: may extend and be applied to bodies politic and corporate, and to partnerships and other unincorporated associations. See Missouri Laws 1.020
  • Polling place: the voting place designated for all voters residing in one or more precincts for any election. See Missouri Laws 115.013
  • Property: includes real and personal property. See Missouri Laws 1.020
  • State: when applied to any of the United States, includes the District of Columbia and the territories, and the words "United States" includes such district and territories. See Missouri Laws 1.020
  • United States: includes such district and territories. See Missouri Laws 1.020
  • voter: is used in the laws of this state it shall mean registered voter, or legal voter. See Missouri Laws 1.035

3. The statement for persons voting absentee ballots pursuant to the provisions of subsection 4, 5, or 6 of section 115.277 without being registered shall be in substantially the following form:

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State of Missouri
County (City) of ______
I, ______ (print name), declare under the penalties of perjury that I am a citizen of the United States and eighteen years of age or older. I am not adjudged incapacitated by any court of law, and if I have been convicted of a felony or of a misdemeanor connected with the right of suffrage, I have had the voting disabilities resulting from such conviction removed pursuant to law. I hereby state under penalties of perjury that I am qualified to vote at this election.
I am an interstate former resident of Missouri and authorized to vote for presidential and vice presidential electors.
I further state under penalties of perjury that I have not voted and will not vote other than by this ballot at this election; I marked the enclosed ballot in secret or am blind, unable to read or write English, or physically incapable of marking the ballot, and the person of my choosing indicated below marked the ballot at my direction; all of the information on this statement is, to the best of my knowledge and belief, true.
__________________ Subscribed to and
Signature of Voter sworn before me this
______ day of
______, ______
__________________
__________________ __________________
Address of Voter Signature of notary or
other officer
authorized to
administer oaths
__________________ __________________
Mailing Address (if different) __________________
__________________
__________________ __________________
Signature of Person Address of Last
Assisting Voter Missouri Residence
(if applicable)

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4. The statement for persons voting absentee ballots who are entitled to vote at the election pursuant to the provisions of subsection 2 of section 115.137 shall be in substantially the following form:

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State of Missouri
County (City) of ______
I, ______ (print name), declare under the penalties of perjury that I expect to be prevented from going to the polls on election day due to (check one):
______ absence on election day from the jurisdiction of the election authority in which I am directed to vote;
______ incapacity or confinement due to illness or physical disability on election day, including caring for a person who is incapacitated or confined due to illness or disability and resides at the same address;
______ religious belief or practice;
______ employment as an election authority, by an election authority at a location other than my polling place, as a first responder, as a health care worker, or as a member of law enforcement;
______ incarceration, although I have retained all the necessary qualifications of voting;
______ certified participation in the address confidentiality program established under sections 589.660 to 589.681 because of safety concerns.
I hereby state under penalties of perjury that I own property in the ______ district and am qualified to vote at this election; I have not voted and will not vote other than by this ballot at this election. I further state that I marked the enclosed ballot in secret or that I am blind, unable to read and write English, or physically incapable of marking the ballot, and the person of my choosing indicated below marked the ballot at my direction; all of the information on this statement is, to the best of my knowledge and belief, true.
__________________ Subscribed and sworn
Signature of Voter to before me this
______ day of
______, ______
__________________
__________________ __________________
Address Signature of notary or
other officer
authorized to
administer oaths
__________________
Signature of Person
Assisting Voter
(if applicable)

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5. The statement for persons providing assistance to absentee voters shall be in substantially the following form:

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The voter needed assistance in marking the ballot and signing above, because of blindness, other physical disability, or inability to read or to read English. I marked the ballot enclosed in this envelope at the voter’s direction, when I was alone with the voter, and I had no other communication with the voter as to how he or she was to vote. The voter swore or affirmed the voter affidavit above and I then signed the voter’s name and completed the other voter information above. Signed under the penalties of perjury.
Reason why voter needed assistance: ______
ASSISTING PERSON SIGN HERE
1. ______ (signature of assisting person)
2. ______ (assisting person’s name printed)
3. ______ (assisting person’s residence)
4. ______ (assisting person’s home city or town).

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6. Notwithstanding any other provision of this section, any covered voter as defined in section 115.902 or persons who have declared themselves to be permanently disabled pursuant to section 115.284, otherwise entitled to vote, shall not be required to obtain a notary seal or signature on his or her absentee ballot.

7. Notwithstanding any other provision of this section or section 115.291 to the contrary, the subscription, signature and seal of a notary or other officer authorized to administer oaths shall not be required on any ballot, ballot envelope, or statement required by this section if the reason for the voter voting absentee is due to the reasons established pursuant to subdivision (2) of subsection 3 of section 115.277.

8. No notary shall charge or collect a fee for notarizing the signature on any absentee ballot or absentee voter registration.

9. A notary public who charges more than the maximum fee specified or who charges or collects a fee for notarizing the signature on any absentee ballot or absentee voter registration is guilty of official misconduct.

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