Absentee Ballot Request Form

Please provide the following information.  Fields in RED with an '*' are required.
  Voter Id
  Birth Date   example. 05/27/1965
  Name*
  Resident Address*
  City*     State*     Zip*
Daytime Phone (ex. 772-555-1212)
Out of County phone
Email Address
Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.
 
Send Ballot(s) for the following elections:
The Town of St. Lucie Village 5/4/2010
Primary Election 8/4/2010
General Election 11/2/2010
All ballots I am eligible for through the next two regularly scheduled general elections
 
MAIL BALLOT TO:         Same as address above
Address
Address 2
City    State   Zipcode
 
Please choose the appropriate status:
 
MILITARY OTHER