05:02:10:01.03Combined absentee ballot application/return envelope.

The application for an in-office absentee ballot must be printed in the following form on an envelope used for sealing the voted ballot: APPLICATION FOR IN-OFFICE ABSENTEE BALLOT ___________________ COUNTY, SOUTH DAKOTA My printed name as it appears on the voter registration list is:____________________________ My voter registration residence address is: ___________________________________________ (address) (city) If your voter registration address is a commercial mail receiving agency, mail forwarding service, or other post office box, please provide a description of the location of your residence in the space provided:______________________________________________________________ Check the election for which you are requesting an absentee ballot: □ Primary If you are registered as an independent or no party affiliation voter and are requesting a primary ballot, you may have a choice of ballots. Please choose one of the following: (Here list ballot choices.) □ General □ Municipal □ School □ Special ___________________(specify jurisdiction) If request is for a municipal or school election: I have lived in that jurisdiction at least 30 days in the last year. Yes □ No □ I am a full-time postsecondary student who resided in that jurisdiction immediately prior to leaving for postsecondary education. Yes □ No □ I am on active duty as a member of the armed forces and my home of record is in that jurisdiction. Yes □ No □ I, under penalty of impersonating a registered voter (2 years imprisonment and $4,000 fine), state that I am the person named above, these statements made by me are true and correct, and that I will vote the ballot which will be enclosed in this envelope. _____________________________________ ___________________ Voter Signature Date INSTRUCTIONS TO THE VOTER Mark your ballot privately. Do not fold your ballot. Place your ballot in this envelope and seal it securely. Return the envelope immediately to the person in charge of the election. Auditor Office Use Only: Voter Precinct: ________ Type of ID: _________ Printer's Note: When this form is printed for primary, general, or other county elections, reference to municipal and school elections may be omitted. The instruction to "not fold your ballot" may be changed if the ballot is to be folded.

Source: 32 SDR 225, effective July 3, 2006; 33 SDR 230, effective July 1, 2007; 36 SDR 112, effective January 11, 2010; 52 SDR 32, effective September 29, 2025; 52 SDR 32, effective January 1, 2026.