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Absentee Ballot Request Service

You can print your own absentee ballot application, ready to mail to your local Municipal Clerk (and we'll provide you with the mailing address), by filling out this form and clicking the 'Go' button at the bottom of the page.

You will need Adobe Acrobat Reader to view and print your PDF absentee ballot request form.

1. Full Name of Voter Requesting the Ballot:

2. Residence Address of Voter:

(Street Address)

(Municipality)

3. Voter's Date of Birth:

/ / (mm/dd/yyyy)

4. Daytime Phone Number (optional):

5. *Enrollment Status:

Democratic Green Independent Republican Unenrolled

6. Method of Delivery of Ballot to the Voter:

In Person (Application Required Only if Voter will vote outside the Municipal Clerk's Presence)

By Mail to this Address:

By Immediate Family Member of Voter Designated Here:

(Name)

(Relationship to Voter)

By 3^rd Person (Designated by the Voter):

(Name)

(Telephone Number)

Absentee Ballot Request Service

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