Nebraska Revised Statutes Chapter 32. Elections § 32-934. New or former resident; affidavit required; contents

1. I am a citizen of the United States.

2. Before moving, I resided at the following address (describing it by street and number if in a city or village and by section, township, and range if outside of a city or village, and the precinct, city, county, and state in which such residence is located):

3. On the day of the next presidential election, I will be at least the constitutionally prescribed age of a voter and I reside at the following address:

4. I am unable to vote for all offices because the voter registration deadline has passed and, under the Election Act, I believe I am entitled to vote for the candidates for President and Vice President of the United States at the election to be held November ____, 20 ____ .

5. I hereby make application for a presidential and vice-presidential ballot. I have not voted and will not vote otherwise than by this ballot for President and Vice President.