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2. Online Request for the Absentee By Mail Application Form For 2023 General Election
4. Please note any question with a red * requires an answer. You will find that almost every question will require an answer. You will not be able to submit this form until all fields with the red * are completed.
6. Voter's Contact Information
8. Voter's First Name*
9. Voter's Last Name*
10. Date Of Birth*
    Date Of Birth
12. Voter's Residence Street Address*
14. City
15. State
16. Zip
18. Daytime Phone Number*
19. Email Address*
21. Is Your Mailing Address Different Than Your Street Address?*

    1. Yes

    1. No
23. Voter's Mailing Address*
25. City*
26. State*
27. Zip*
29. Request for the Absentee By Mail Application Form Processing Information
31. How Should We Send You The Absentee By Mail Application Form?*

    Select One

    1. By Regular Mail

    1. By Email
33. Disclosures
35. Your completed Absentee By Mail Application Form MUST Be Returned To Us And RECEIVED No Later Than 11:59 PM On Thursday, October 26, 2023. If It Is Not Received By The Deadline, You Will Not Be Able To Vote Absentee By Mail.*

    1. I understand and agree.
37. You are almost done! Please click on "Submit" or "Submit & Print" below and you will be directed to a Form Submission Confirmation Page. If you are not directed to the Form Submission Confirmation Page, then you have probably missed providing required information on this form. Please scroll up to see any highlighted fields where an answer is required, then click on "Submit" Or "Submit & Print" again.
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit Submit and Print

* indicates a required field