(a) that he or she is the victim of domestic violence;
  (b)  that  he  or  she  has  left his or her residence because of such
violence; and
  (c) that because of the  threat  of  physical  or  emotional  harm  to
himself  or  herself or to family or household members, he or she wishes
to cast a special ballot  in  the  next  election.  The  statement  must
include  the  voter's  address  of  registration. The board of elections
shall permit such a voter to cast a special ballot at an office of  such
board  of  elections  not  later than the close of the polls on election
day, or by mail within the same time and in the  same  manner  in  which
absentee  ballots may be cast, provided however that the distribution of
such ballots to such  voters  shall  be  timed  to  afford  such  voters
sufficient  time to cast such ballots prior to the close of the polls on
election day. Such ballots shall be retained at the board  of  elections
and  cast  and  canvassed pursuant to the provisions of section 9-209 of
this chapter.
  2. "Family or household members" mean the following individuals:
  (a) persons related by consanguinity or affinity;
  (b) persons legally married to one another;
  (c) persons formerly married to one another regardless of whether they
still reside in the same household;
  (d) persons who have a child in  common  regardless  of  whether  such
persons are married or have lived together at any time; or
  (e)  persons  who are not related by consanguinity or affinity and who
are or have been in an intimate relationship regardless of whether  such
persons have lived together at any time.