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Vote By Mail - Ballot Application

Use the form below to request a vote by mail ballot for the Consolidated Election April 4, 2017.

If you prefer to print and mail in your request, download the form here.

First Name:
Last Name:
Residence Address:  
Street:
City:
State:
Zip:
Mailing Address:
Street:
City:
State:
Zip:
Daytime Phone:
Email Address:
Date of Birth:
Last 4 Digits of SSN:


Note:  If application is submitted electronically the applicant shall click on the Submit button below, certifying that the statements set forth in this application are true and correct, and a signature is not required.