HomeMy Public PortalAbout2024 Vote by Mail Application Massachusetts _ =
'��� - ��"���`' William Francis Galvin
Voteb M a i l A pp i i cat i o n 7� ;�`c Secretary of the Commonwealth
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Section 1-Voter Information:
Name:
Address of Voter Registration: - -
Ballot Mailing Address (if different):
Date of Birth: Phone Number (optional):
E-mail Address (optional): _ -
Section 2 - Ballot Information:
Elections:
❑All elections this year
❑A specific election (date): ----
Primary Ballots (choose one):
❑Democratic
❑Republican
❑Libertarian
❑No Primary Ballots
Section 3 -Assistance:
❑ 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:
r >Signed (under penalty of perjury): _ Date:
i-
Completing the Application
1. Voter Information- Provide your name, the address where you are registered to vote, your ballot mailing
address (if different)and date of birth.
2. Ballot Information-Choose which ballot(s) you want to receive by mail.
Choose a primary ballot option if you are not registered in a party.
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.