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For use ONLY for Elections on or before June 23, 2020

  1. 1. I am requesting, in good faith, an absentee ballot due to (check one reason):*

  2. 2. Absentee ballot(s) requested for the following election(s) :*

  3. 5. Address where you live (residence)

  4. 6/7. Address where you would like your absentee ballot mailed to.

  5. Leave This Blank:

  6. This field is not part of the form submission.