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Application for Official Absentee by Mail Ballot

A completed application must be downloaded, signed and returned to us to receive an absentee ballot.


Election Date:

Ballots may be requested up to 180 days prior to the election. I hereby request a ballot be issued to me for the following election: *



Voter Information:

Name as registered *
Date of birth *
Address as registered *
(no PO Box)
Street # and name Apartment #
City State ZIP code
Mail ballot to *
(PO Box allowed)
Street # and name / PO Box Apartment #
City State ZIP code
GA DL or ID# *
(Optional)
Last four digits of SSN *
(Optional)

Signature Information:

Are you requesting a ballot for another voter?
You may apply on behalf of another person only in the following circumstances: In the case of a voter temporarily residing out of the county or a physically disabled voter residing within the county, application may be made by mother, father, grandparent, brother, sister, aunt, uncle, spouse, son, daughter, niece, nephew, grandchild, son-in-law, daughter-in-law, mother-in-law, father-in-law, brother-in-law, sister-in-law of the age of 18 or over.




Verification:

Verification Code Enter the verification code *