Form Center

2. Last Name*
3. First Name*
5. Date of Birth*
   Date of Birth
7. Residence Address*
9. Mail Ballot to*
11. Party Affiliation – must match your voter registration record to process your absentee request

    1. Democratic (Your Primary Election ballot will only contain Democratic candidates and non-partisan races)
    2. Republican (Your Primary Election ballot will only contain Republican candidates and non-partisan races)
    3. Other/Unaffiliated (Your Primary Election ballot will only contain non-partisan races)

    To Change your Party Affiliation: Present a valid photo ID at our office or at the polls on Election Day.
13. Daytime Phone
14. Email
16. Please select any of the following boxes if they apply:

    1. Domestic Military
    2. Overseas Military
    3. Overseas Citizen
17. Please also indicate for which elections you wish to receive an absentee ballot: *

    1. Primary Only
    2. General Only
    3. Special Election Only
    4. Primary and General Elections
    5. All elections for which you are a qualified elector that occur during the year (includes special elections)
Leave This Blank:


19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field