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Absentee Ballot Request

  1. (i.e. General Primary Election)

  2. What is the Address that you want the ballot to be mailed to?

  3. I would like to receive my ballot by electronic transmission.

  4. Is Your Mailing Address the Same as your Physical Address?

  5. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  6. Leave This Blank:

  7. This field is not part of the form submission.