Vote by Mail Ballot

Applicant's Name:(*)

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Street Address:(*)

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City:(*)

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State:(*)

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Zip Code:(*)

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County:

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Date of Birth:(*)

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Phone Number:

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Email:(*)

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Address to which ballot should be mailed (if different from above):

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By marking one of the options below you will be applying for PERMANENT vote by mail status.

I wish to vote by mail in all subsequent elections that do not require a party designation.

I wish to vote by mail in all subsequent elections and wish to receive the party ballot indicated below in all elections that require a party designation (Voter MUST select party below).

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By marking the option below, you will be applying for a SINGLE vote by mail status.

I wish to vote by mail in the current election as specified above. (If primary election, Voter MUST select party below)

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I request a ballot for the:

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NOTE: a nonpartisan ballot will not contain offices or candidates, only questions or referendum.

By checking the box, you are acknowledging the information below.(*)

I Agree

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