acvote header

To obtain a Vote by Mail Ballot, complete the information on this form.

1. Name

2. Date of Birth (*REQUIRED)

(eg. 01/31/1900)

3. Residence Address

(Where you live)

4. Mailing Address

(Where you receive your mail)

5. Email Address

6. Phone Number

7. Terms

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.