Voter Registration And Absentee Ballot Request

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Voter registration and absentee ballot request
Please use the state-specific
instructions available in the Voting
Assistance Guide at fvap.gov.
For U.S. citizens residing overseas and all U.S. Military members
Federal Post Card Application (FPCA)
Please print in black ink.
Last name
Suffix
Name
1
Enter your legal name as you usually
First name
Middle Initial
do on official forms. Use the name that
appears on your driver’s license or ID.
Previous name (if applicable)
M
F
Birth date
Sex
Race
Identification
2
Social Security Number
ID requirements vary. Check your
state’s instructions at fvap.gov.
or State driver’s license or ID
Telephone
Contact information
Fax
This information is used by your
3
election official in case of questions.
Email
Include country code, no DSN number.
Please include your email address.
Alternative telephone and/or email
1 = most preferred. 2 = second-most preferred. 3 = least preferred. 0 = not available.
Ballot delivery method
4
Email/Online
Postal Mail
Fax
Rank how you prefer to get your ballot.
Address where you want
Address (not P.O. Box)
Apt. Number
to register and vote
5
City/Town/Village
Military voters: use your legal
U.S. residence. Civilian voters:
County
State
Zip code
Use your last U.S. address.
Address where you
get mail
6
Enter the address where you want
voting materials to be sent. This must
be different than above. You may enter
a forwarding address in Section 9.
I am a member of the Uniformed Services or Merchant Marine on active duty.
Military
I am an eligible military spouse or dependent.
I am an activated National Guard member on State orders.
Classification
7
Check one. Choose the voter
I am a U.S. citizen permanently or indefinitely residing outside the U.S.
classification that best describes
I am a U.S. citizen and have never resided in the United States.
your current situation.
Civilian
I am a U.S. citizen temporarily residing outside the U.S., and upon my return I will reside at the
voting residence address listed on this form.
I am a U.S. citizen temporarily residing outside the U.S., and I am not certain of my future address.
8
Political party
Optional. To vote in primary elections, most states require you to specify a political party.
Additional requirements
from your state
9
Check your state’s instructions at
fvap.gov. If you need mail forwarded
to you, put that address here.
I request an absentee ballot for all elections in which I am eligible to vote.
You must sign and send in.
Signature
Affirmation (required):
Today’s date
I swear or affirm, under penalty of perjury, that:
• The information I have provided is true, accurate, and complete.
• I understand that giving information on this form that is not true may be a crime.
Witness signature / date if required by your state.
• I am qualified to vote as far as I know.
See the Voting Assistance Guide at fvap.gov.
• I am registering, requesting a ballot, and voting only in the place I named on this form.
This information is for official use only. Any unauthorized release may be punishable by law.
Standard Form 76 (Rev. 05-2013), OMB No. XXX-XXXX

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