Form Sbe-701 - Virginia Absentee Ballot Application printable pdf download

Form Sbe-701 - Virginia Absentee Ballot Application

V I R G I N I A

DEPARTMENT

ELECTIONS

Virginia Absentee Ballot

Application Form

You can check the status of your absentee ballot

Department of Elections Contact Info:

request and ballot by calling your local General

Phone: (804) 864-8901

Toll Free: (800) 552-9745

Registrar, the Department of Elections toll free

Fax: (804) 371-0194

TTY: 711

number or checking through the Department of

Email: info@elections.virginia.gov

Elections website:

Privacy Act Notice:

This form collects personal information, including your social

WARNING:

INTENTIONALLY VOTING MORE THAN ONCE IN AN

security number, for identification and to prevent fraud. Your

ELECTION OR MAKING A MATERIALLY FALSE STATEMENT ON

application will be denied if you fail to provide the last four

THIS FORM CONSTITUTES THE CRIME OF ELECTION FRAUD,

digits of your social security number or any other information

required to determine your qualification to vote absentee.

WHICH IS PUNISHABLE UNDER VIRGINIA LAW AS A FELONY.

Federal law (the Privacy Act) and state law (Va. Code § 24.2-

VIOLATORS MAY BE SENTENCED TO UP TO 10 YEARS IN PRISON,

701 and the Government Data Collection and Dissemination

OR UP TO 12 MONTHS IN JAIL AND/OR FINED UP TO $2,500.

Practices Act) authorize collecting this information and restrict

its use to official purposes only.

SBE-701 Rev. 07/2017

Form Sbe-701 - Virginia Absentee Ballot Application