absent ballot request - washoe county, nevadatelephone no. : _ e-mail address:_ 6 mark...

Washoe County Absent Ballot Request 1 Last Name First Name Middle Name/Initial 2 Date of Birth (mm/dd/yyyy) Your Nevada Driver’s License or State ID Number (if none, last four digits of SS No.) 3 Address Where You Live In Washoe County City State Zip 4 Address For Mailing the Absent Ballot (If Different From #3) City State Zip (Absent Ballots are not forwardable, must be an address where you can receive mail) 5 Daytime Phone Number and/or E-mail should we need to contact you regarding any problems with your Absent Ballot Telephone No. : ____________________ E-Mail Address:________________________________________________________________ 6 Mark Election(s) for Which You Are Requesting An Absent Ballot: PRIMARY GENERAL ALL Elections I am eligible to vote during the year this form is submitted. I REQUEST PERMANENT STATUS (Notice: If you surrender your Absent Ballot to vote in person, you may be required to re-apply for Permanent Status.) *If you are Active Duty Military or an Overseas Citizen, please contact our office to discuss the availability of some additional voting options. 7 This form must be signed by the voter requesting the Absent Ballot: _X___________________________________________________________________________________ _______________________ Voter’s Signature 1 Date 1 Voters unable to sign or mark a ballot please contact the Washoe County Registrar of Voter’s Department at (775) 328-3670 for instructions. WARNING! If you have registered to vote by mail, and you have never voted at the polls in this State, you may be required to submit a copy of your ID (example: Driver’s License) with your voted Absent Ballot unless: • You have provided a form of identification or valid proof of residence to the County Registrar; or • You provided your Driver's License number, ID Card or the last 4 digits of your Social Security Number at the time you registered to vote; or • You are in the military or overseas; or • You request an Absent Ballot in person at the office of the County Clerk/Registrar. NOTICE: This is a request for an Absent Ballot. By completing and returning this form to the Washoe County Registrar of Voters Office, you are submitting a request for an Absent Ballot. This form must be received by the Washoe County Registrar of Voters Office no later than 5 p.m. on the 14 th calendar day preceding the election. You may vote only by Absent Ballot unless you surrender your ballot or provide identification and sign an affidavit declaring you have not voted in the election. Requested Ballots will begin mailing out approximately: Military/Overseas Citizens - 45 days prior to election day. Out of State Voters – 40 days prior to election day. Local Voters – 30 days prior to election day. Return this completed form by Mail, Fax or Email to: Mail: Registrar of Voters 1001 E. 9 th St. Reno NV 89512 Fax: (775) 328-3747 Email: [email protected] (office use only) __________ Transaction Number __________ Sig OK

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Page 1: Absent Ballot Request - Washoe County, NevadaTelephone No. : _____ E-Mail Address:_____ 6 Mark Election (s) for Which You Are Requesting A n Absent Ballot: PRIMARY GENERAL ALL Elections

Washoe County Absent Ballot Request

Last Name First Name Middle Name/Initial

Date of Birth (mm/dd/yyyy) Your Nevada Driver’s License or State ID Number (if none, last four digits of SS No.)

Address Where You Live In Washoe County City State Zip

Address For Mailing the Absent Ballot (If Different From #3) City State Zip (Absent Ballots are not forwardable, must be an address where you can receive mail)

Daytime Phone Number and/or E-mail should we need to contact you regarding any problems with your Absent Ballot

Telephone No. : ____________________ E-Mail Address:________________________________________________________________

Mark Election(s) for Which You Are Requesting An Absent Ballot:

PRIMARY GENERAL ALL Elections I am eligible to vote during the year this form is submitted.

I REQUEST PERMANENT STATUS (Notice: If you surrender your Absent Ballot to vote in person, you may be required to re-apply for Permanent Status.)

*If you are Active Duty Military or an Overseas Citizen, please contact our office to discuss the availability of someadditional voting options.

This form must be signed by the voter requesting the Absent Ballot:

_X___________________________________________________________________________________ _______________________

Voter’s Signature1 Date

1Voters unable to sign or mark a ballot please contact the Washoe County Registrar of Voter’s Department at (775) 328-3670 for instructions.

WARNING! If you have registered to vote by mail, and you have never voted at the polls in this State, you may be required to submit a copy of your ID (example: Driver’s License) with your voted Absent Ballot unless:

• You have provided a form of identification or valid proof of residence to the County Registrar; or

• You provided your Driver's License number, ID Card or the last 4 digits of your Social Security Number at the time you registered to vote; or

• You are in the military or overseas; or• You request an Absent Ballot in person at the office of the County Clerk/Registrar.

NOTICE: This is a request for an Absent Ballot. By completing and returning this form to the Washoe County Registrar of Voters Office, you are submitting a request for an Absent Ballot. This form must be received by the Washoe County Registrar of Voters Office no later than 5 p.m. on the 14th calendar day preceding the election. You may vote only by Absent Ballot unless you surrender your ballot or provide identification and sign an affidavit declaring you have not voted in the election.

Requested Ballots will begin mailing out approximately: Military/Overseas Citizens - 45 days prior to election day.

Out of State Voters – 40 days prior to election day. Local Voters – 30 days prior to election day.

Return this completed form by Mail, Fax or Email to: Mail: Registrar of Voters

1001 E. 9th St. Reno NV 89512

Fax: (775) 328-3747 Email: [email protected]

(office u

ly)

__________

Transactio

____

_____

Sig OK