(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.