Mail Ballot Signature Form
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1COUNTY OF SAN DIEGO
REGISTRAR OF VOTERS
5600 OVERLAND AVE., SAN DIEGO, CA 92123
Phone (858) 565-5800 Fax (858) 505-7294
MAIL BALLOT SIGNATURE FORM
NOTICE: YOU DID NOT SIGN YOUR VOTE-BY-MAIL RETURN ENVELOPE
READ INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM.
FAILURE TO FOLLOW THESE INSTRUCTIONS MAY CAUSE YOUR BALLOT NOT TO BE COUNTED.
This form must be completed and returned to the Registrar of Voters office as soon as possible so that it can be received
no later than 5 p.m. on the eighth day after Election Day. You must fill out this form completely and sign your name
below on the line next to Voter Signature. You may return this form by:
•
COMING to the Registrar of Voters office in person to sign your original Vote-By-Mail Ballot envelope or
dropping-off this Mail Ballot Signature Form after signing, Monday through Friday 8 am to 5 pm. This Form must
be received by 5 pm on the eighth day after Election Day.
OR
•
MAILING your signed Form to our office. Signed Form must be received at the Registrar of Voters office by 5pm
on the eighth day after Election Day (Postmark Not Acceptable). If you choose to return it by mail, you must
place postage on the return envelope.
OR
•
DROPPING-OFF your signed Form at a polling place or a designated ballot drop-off site in San Diego County on
Election Day before 8 pm.
OR
•
FAXING the signed Form to the Registrar of Voters office at (858) 505-7294. It must be received at our office by
5 pm on the eighth day after Election Day.
I,
, am a registered voter of San Diego County,
(Print Name of Voter)
State of California. I do solemnly swear (or affirm) that I returned a Vote-By-Mail ballot and that I have not and will not
vote more than one ballot in this election. I understand that if I commit or attempt any fraud in connection with voting,
or if I aid or abet fraud or attempt to aid or abet fraud in connection with voting, I may be convicted of a felony
punishable by imprisonment for 16 months or two or three years. I understand that my failure to sign this statement
means that my Vote-By-Mail ballot is not eligible to be counted.
COMPLETE ALL INFORMATION
VOTER SIGNATURE: ________________________________________________________________________
DO NOT PRINT
(Power of attorney cannot be accepted)
DATE: ___________________________________________________________________________________
WITNESS: ________________________________________________________________________________
(If voter is unable to sign, s/he may make a mark witnessed by one person over the age of 18 years.)
REGISTERED RESIDENCE ADDRESS: _____________________________________________________________
(Street Address)
_______________________________________________________________________________________
(City)
(State)
(Zip Code)
DATE OF BIRTH: ___________________________________________________________________________
FOR VOTE-BY-MAIL STAFF USE ONLY
AVID #: ____________________________________________
Date Verified: __________________________________
Batch #: ____________________________________________
Initials: _______________________________________
Env #: ____________________________________________
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