Indian River County, FL, Supervisor of Elections

Mail Ballot Request Form

Notice:
Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public-records request, do not use this form as it will send electronic mail to our office. Instead, contact this office by phone or in writing.
A request for a mail ballot to be mailed must be received by the Supervisor of Elections no later than 5:00 p.m. on the sixth day before the election.
This request is valid for only one (1) registered voter. If you are a qualified and registered voter, ballots will be mailed only for the elections checked. Mail ballots are mailed approximately 30 days prior to each election to those voters who have requested a mail ballot.
MAIL BALLOTS CANNOT BE FORWARDED BY THE POST OFFICE. If you will not be at your IndianRiver County address, please complete the MAIL BALLOT TO portion of this form with the address to which you want the ballot mailed.

( * Denotes a required field)

* Are you making this request for someone in your immediate family?

Yes      Myself

Voter Information:

* Voter's First Name:

Voter's Middle Initial:

*  Voter's Last Name:

*  Voter's Birth Date (mm/dd/yyyy):

*  IndianRiver County Residence Address (No PO Box):

:

*  Voter's City:

*  Voter's ZIP Code:

Voter's email address:

Voter's Daytime Phone:

Voter ID Number(if available):

Mail Ballot to: (if different from above)

Street, PO Box, Rural Route:

Apartment, Lot, or Unit Number:

City:

State:

ZIP Code:





Mail ballots must be mailed to the current mailing address on file with the supervisor of elections, unless the voter is:

Absent from the county, and does not plan to return before the day of the election.
Temporarily unable to occupy the residence because of natural disaster.
In a hospital, assisted living facility, nursing home, short-term medical or rehabilitation facility, or correctional facility.
Changing his or her current mailing address on file to

Street, PO Box, Rural Route:

Apartment, Lot, or Unit Number:

City, State, ZIP Code:

Mail ballot Status:

Civilian Overseas
Military/Dependent Overseas
Military/Dependent Stateside
Not Applicable

Mail ballots requested:

All Elections Through the Next Two General Elections (2012)

08/24/2010 - 2010 Primary Election
11/02/2010 - 2010 General Election

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