Application To Access Absentee Ballot Request Information
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1F
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S
-D
E
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LORIDA
EPARTMENT OF
TATE
IVISION OF
LECTIONS
A
A
PPLICATION TO
CCESS
A
B
R
I
BSENTEE
ALLOT
EQUEST
NFORMATION
Absentee ballot request information is confidential and exempt from public disclosure under section 101.62(3),
Florida Statutes, except to the following persons or entities who may obtain and use it for political purposes only:
1) Canvassing board, 2) Election official, 3) Political party or official thereof, 4) Registered political committee, 5)
Candidate who has filed qualification papers and is opposed in an upcoming election, and 6) Voter (entitled only to access
his or her own absentee ballot request information directly from Supervisor of Elections for county of residence).
For electronic access to absentee ballot request information posted on the Division of Elections’ website as forwarded by
the Supervisors of Elections, check the applicable authorization category and submit this completed form:
_____ Canvassing Board
_____ A candidate who has filed qualification
papers & is opposed in an upcoming election
_____ An election official
_____ Political Committee
_____ A political party or official thereof
Requester’s Name: ___________________________________________ Title/Officer: ____________________
Address: ___________________________________________________ Phone No.: ______________________
(Street address, city, state, zip code)
I affirm that I am a person authorized by Section 101.62(3), Florida Statues, to acquire absentee ballot request information.
X_________________________________________________________
________________________
S
P
I
D
IGNATURE OF
ERSON REQUESTING
NFORMATION
ATE
I also designate the following person acting on my behalf to receive and use my username and password to
obtain this information:
Name: _______________________________________________ Title/Officer: ________________________
Address: _____________________________________________ Phone No.: _________________________
(Street address, city, state, zip code)
Please submit completed form to:
Florida Department of State, Division of Elections
Bureau of Voter Registration Services
500 South Bronough Street, Room 316
Tallahassee, Florida 32399
A completed form may also be faxed in the
F
O
U
O
OR
FFICIAL
SE
NLY
interim to 850-245-6291.
Date received: ____________________________
Call 850-245-6180 if you need further help.
Username: _______________________________
A username and password for electronic access
Password: _______________________________
Date called: ______________________________
will be assigned and mailed to you.
Date mailed: _____________________________
L
:
OGIN AT
https://doe.dos.state.fl.us/fvrscountyballotreports
Note: Except for your username and password, all information on this form becomes a public record upon filing with the Division of Elections.
101.62, Florida Statutes.
DS-DE 70 (eff. 2-4-10/R1S-2.043, F.A.C.)
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