mail ballot request douglas county clerk-treasurer · mail ballot request douglas county...
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MAIL BALLOT REQUEST
Douglas County Clerk-Treasurer Mail Ballots are not forwardable. You must provide a valid address for ballots to be mailed.
Residential address on form must match current voter registration record. If you've recently moved, please update your address before submitting this request. Visit govotedouglas.com to
view/update your voter registration record or call (775)782-9014 for more info.
Requests must be received by the Clerk no later than 5 p.m. on the 7th day preceding any election. 1 Last Name First Name Middle Name or Suffix
2 Residential address where you LIVE in Douglas County (Street, City, State, Zip)
3 Mailing address where you receive mail, if different from residential (Street, City, State, Zip)
4 Ballot address where ballot will be mailed, if different from residential or mailing (Street, City, State, Zip)
5 Will you be temporarily away during an election? If no, skip this section. Yes, I will be temporarily away from ____________________________ to _________________________ and during that
time, ballots should be mailed to the ballot address from section 4.
This is a reoccurring trip.
6 Date of Birth 7 DL#, ID# or Last 4 Digits of SSN
8 Beginning in 2018, voters that are at least 65 years of age or self-identify as having a physical disability may request permanent mail ballots. Once a permanent mail ballot request is made you will receive mail ballots for all elections in which you are eligible to vote in. You will continue to receive mail ballots until you cancel your registration, withdraw your request to receive permanent mail ballots or until you no longer have a valid address.
I am at least 65 years of age or self-identify as having a physical disability and request to receive mail ballots permanently. If you receive permanent mail ballots you must maintain your addresses.
If you do not meet the requirements above or you are not interested in receiving permanent mail ballots, you may request a mail ballot for all elections held during the year you make the request. Please mark the election(s) which you are requesting a mail ballot.
Primary General Special All
9 Military Domestic Military Overseas Civilian Temporarily Overseas Civilian Overseas and my Return is
Unknown
10 Please Sign & Date Below(cannot be a computerized font, must be actual "wet"signature)
X_______________________________________________________________________________________ Date _______________________
You may return this form: [email protected] 1616 8th St, Minden(775)782-9016 PO Box 218, Minden, 89423
Approved 12/19/17
Are you currently serving in the Military or living overseas? If no, skip this section. This request is for a ballot to be mailed to you. Please check the box that best describes your status. If you would like an email or fax ballot DO NOT complete this form. Please complete the FPCA, visit the Nevada Secretary of State's EASE website, visit govotedouglas.com or call (775)782-9014.
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