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2. Please complete the Absentee Voter List Request form to be added to the Permanent AV List. When there is an election, the application for a ballot will be automatically sent to you. You must return the signed application to receive the ballot.

4. Full Name: *
6. Street Number:*
8. Street Name:*
9. Unit Number / Apartment Number*
11. Phone Number or Email:*
12. Year of Birth:*
Leave This Blank:


14. 1. Receive an email copy of this form.
15. Email address

    This field is not part of the form submission.

16. Submit

* indicates a required field