Complete the form below to schedule your Ballot Will Call pick-up. If you provide an email, our office will notify you when the ballot is ready for pickup. All requests must be submitted by 3 PM for next day pickup.

1. Election

2. Name

3. Date of Birth (*Required)

(eg. 01/31/1900)

4. Residence Address

(Where you live)

5. Email Address

6. Phone Number

7. Permanent Vote by Mail

I am requesting to become a permanent Vote by Mail Voter. A Vote by Mail ballot will automatically be sent to me in all future elections. I understand that if I fail to Vote by Mail in four (4) consecutive statewide general elections, I will need to reapply for permanent Vote by Mail status.


8. Pick Up Location

9. Cross-Over Party

I have declined to disclose a preference for a qualified political party. The below-listed political parties are allowing crossover voting in this election. For this election only, I request a ballot for the following political party (select only one):

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.

A BALLOT WILL NOT BE SCHEDULED FOR PICK-UP IF THIS APPLICATION IS INCOMPLETE OR INACCURATE.

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