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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:
All ballots I am eligible for through the next two regularly scheduled general elections
Primary  Election - August 26, 2008 (Includes City of Port St. Lucie Primary Election)
General  Election - November 4, 2008 (Includes City of Port St. Lucie Primary Election)
 
MAIL BALLOT TO:         Same as address above
Address
Address 2
City    State   Zipcode
 
Please choose the appropriate status:
 
MILITARY OTHER