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2. 

3. General Election Day - November 8, 2022

5. Complete the following form to receive an early ballot for the 2022 General Election. The last day to request an early ballot be mailed to you is October 28, 2022 for the General Election. Please note: If you are on the Active Early Voting List, you do not need to submit this form unless you want your ballot mailed to a different address from what is on your voter registration record. Thank you!

7. First Name *
8. Middle Initial
10. Last Name*
11. Senior (Sr), Junior (Jr), III
13. Birth Date*
15. Residence Address *
17. Apartment / Space
18. City *
20. State *
21. Zip Code*
23. Daytime Phone
25. Email Address
27. Mailing address to send ballot (if different from residence)
29. Mailing City
30. Mailing State
31. Zip Code
33. Please check appropriate box, if applicable

    1. Temporary mailing address for this election only
    2. Please update mailing address on voter record

35. General Election Day - November 8, 2022

Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit Submit and Print

* indicates a required field