Absentee Ballot Request Form
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1KAITI LENHART
FLAGLER COUNTY SUPERVISOR OF ELECTIONS
1769 E. Moody Blvd., Building 2, Suite 101, Bunnell, FL 32110 • P.O Box 901, Bunnell, FL 32110
Phone: (386) 313-4170 • Fax: (386) 313-4171 •Online:
FOUR
TRACK YOUR BALLOT ONLINE!
VOTE BY MAIL IN
EASY STEPS
Make sure your ballot was received by the Elections Office.
1. REQUEST
2. VOTE
3. SIGN
4. DELIVER
Any registered and qualified voter who is
The voter must personally vote their
The voter must sign the return envelope.
You must mail, personally deliver or have
eligible to vote in an election may cast their
ballot. Absentee ballots are mailed 35
Power of attorney is not recognized for
someone else deliver your absentee ballot
vote by absentee ballot. An absentee ballot
days prior to each election to those
absentee voting in the state of Florida.
inside the completed mailing envelope to
may be requested for a specific election
voters who have requested an absentee
The absentee ballot will not be counted if
the Elections Office. Sufficient postage is
or for all elections through the next two
ballot. Be sure the Elections Office has
the return envelope is not signed or if the
required if mailed. Absentee ballots must
regularly scheduled general elections.
your correct mailing address. Absentee
signature does not match the signature
be recieved no later than 7:00 P.M. on
The request can be made in person,
ballots are not forwarded by the US Postal
we have in the voter registration file.
the day of the election. Absentee ballots
by postal mail, by electronic mail or by
Service. Absentee ballots for overseas
An unsigned absentee ballot may be
cannot be turned in at the polling place
telephone. Only the voter or designated
military and overseas civilian voters are
presented to the Canvassing Board for a
on Election Day unless the voter himself
member of his or her immediate family or
mailed 45 days prior to an election.
decision if this affidavit is received before
wishes to vote in person at the polls. If a
legal guardian can request an absentee
5:00 p.m. on the Monday prior to Election
voter has requested an absentee ballot
ballot for the voter. The request deadline is
Day:
and chooses to vote in person at the
always the Wednesday prior to the Election.
Portals/Flagler/pdfs/DS-DE_139.pdf
polls, the absentee ballot is cancelled
and the voter is issued a new ballot.
ATTENTION ABSENTEE VOTERS!
Recent law changes (passed in 2013) now require an absentee ballot request to an address other
Florida Statutes
than the elector’s address on file, must be submitted in WRITING and SIGNED by the voter.
Please print, complete and mail the form below to request an absentee ballot.
EFFECTIVE: 01/01/2014
Request for absentee ballots
ABSENTEE BALLOT REQUEST FORM
101.62 (1)(b):
The supervisor may accept a
written or telephonic request
Please send me absentee ballots for the following election(s): Check One Below
for an absentee ballot to be
mailed to an elector’s address
Specific Election: ________________
All Eligible Elections Through 2018
on file in the Florida Voter
Registration System from the
PLEASE PRINT CLEARLY
elector, or, if directly instructed
VOTER NAME: ___________________________________________
(REQUIRED)
by the elector, a member of the
elector’s immediate family, or
VOTER ID
(IF KNOWN)
DATE OF BIRTH: _____ /_____ / __________
the elector’s legal guardian; if
(REQUIRED)
the ballot is requested to be
mailed to an address other than
ABSENTEE BALLOT MAILING ADDRESS:
(REQUIRED)
the elector’s address on file in
the Florida Voter Registration
Florida law prohibits
Street Address
___________________________________________
System, the request must be
absentee ballots from
or PO Box:
made in writing and signed
being forwarded by the
___________________________________________
by the elector. However, an
Post Office. You must
provide a valid mailing
absent uniformed service voter
City: ________________________ State: ________ Zip: __________
address.
or an overseas voter seeking
an absentee ballot is not
PHONE NUMBER: __________ - __________ - ______________
(OPTIONAL)
required to submit a signed,
Only for use by Elections Staff
written request for an absentee
x
ballot that is being mailed to
_______________________________________________________________________
an address other than the
VOTER SIGNATURE
DATE
elector’s address on file in
(REQUIRED)
the Florida Voter Registration
REQUESTS WITHOUT DATE OF BIRTH AND VOTER SIGNATURE CANNOT BE PROCESSED. COMPLETE REQUEST AND RETURN. FOR PRIVACY, USE AN ENVELOPE.
System.
MAIL TO: SUPERVISOR OF ELECTIONS • P.O. BOX 901 • BUNNELL, FL 32110 EMAIL TO: FAX TO: (386) 313-4171
DELIVER TO: THE SUPERVISOR OF ELECTIONS OFFICE IN THE GOV’T SERVICES BUILDING •1769 E. MOODY BOULEVARD • BUILDING 2 • SUITE 101 • BUNNELL, FL 32110
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