HomeMy Public PortalAbout2022-Vote-by-Mail-Paper-Application2022 Vote by Mail Application William Francis Galvin
Secretary of the Commonwealth
Eligibility
Any registered voter may use this application to request a mail-in ballot for any 2022 election.
Completing the Application
1. Voter Information – Provide your name, the address where you are registered to vote, and date of birth.
2. Ballot Information – Choose which ballot(s) you want to receive by mail. If you’re requesting a primary ballot and
you’re not registered in a party, you must pick a primary ballot. Provide your ballot mailing address.
3. Assistance – If you’re helping someone complete this application, or you’re requesting a ballot for a family member, fill
out this section.
4. Sign your name – If you can’t sign your name, you may ask someone to sign your name in your presence.
Submitting the Application
Send this completed application to the local election office for your city or town. Find contact information for local election
officials at www.VoteInMA.com or by calling 1-800-462-VOTE (8683).
Application Deadlines
This application must reach your local election office by 5 p.m. on the fifth business day before Election Day.
State Primary Deadline: August 29, 2022
State Election Deadline: November 1, 2022
Voter Information
Ballot Information
Assistance
1
2
3
Name:
Address of Voter Registration:
Date of Birth: Phone Number (optional):
E-mail Address (optional):
Elections:
All 2022 Elections*
Sept. 6th State Primary Only*
Nov. 8th State Election Only
* Primary Ballot
Democratic
Republican
Ballot Mailing Address
Voter required assistance in completing application due to physical disability.
Assisting person’s name:
Assisting person’s address:
This application is being made by a family member
Relationship to Voter:
Signed (under penalty of perjury): Date: