Applicant's Name:(*) Invalid Input Street Address:(*) Invalid Input City:(*) Invalid Input State:(*) Select StateALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY Invalid Input Zip Code:(*) Invalid Input County: Invalid Input Date of Birth:(*) Invalid Input Phone Number: Invalid Input Email:(*) Invalid Input Address to which ballot should be mailed (if different from above): Invalid Input 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). Invalid Input 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) Invalid Input I request a ballot for the: Please SelectDemocratic PartyRepublican PartyNonpartisan Invalid Input 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 Invalid Input (*) Invalid Input
