Application for Absentee Ballot

Application for Official Absentee by Mail Ballot

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

Fields marked are required.

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:

For Elderly and Disabled Voters ONLY:

You may choose to complete one application and receive a ballot for the General Primary, General Primary Runoff (if any), General Election, and General Election Runoff (if any) by checking one of the following boxes

I am 65 years of age or older

I have a physical disability

Voter Information:

Name as registered Required

Date of birth Required

Address as registered

Street # and name Required

Apt / Suite / Other

City Required

State

Zip Required

Mail ballot to

Street # and name Required

Apt / Suite / Other

City Required

State

Zip Required

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.

Yes

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