I have not applied for, nor do I intend to apply for, a vote by mail ballot from any other jurisdiction for this election.
By submitting this application, I certify under the laws of the State of California that the name and residence address and information
I have provided on this application are true and correct.
Only the registered voter himself or herself may apply for a vote by mail ballot. An application for a vote by mail ballot
made by a person other than the registered voter is a criminal offense.
A BALLOT WILL NOT BE SCHEDULED FOR PICK-UP IF THIS APPLICATION IS INCOMPLETE OR INACCURATE.