Absentee Ballot Request

Absentee Ballot Request Form
for Lake County Residents

Voter's Personal Information

* First name

Middle name

* Last name

* Date of birth

* E-mail address

Please note: Florida has a very broad public records law. Your email address may be subject to public disclosure. Please contact us at (352) 343-9734, if you would like to request an absentee ballot without disclosing your email address.

* Daytime phone number

Voter ID number (if available)

Requested Election(s)

All Elections*

Presidential Preference Primary
Primary
General Election
Special Election
Other; Election name(s) or date(s):

*NOTE: A person selecting “All Elections” will be scheduled to receive ballots through the next regularly scheduled general election. This means that a person requesting ballots for “All Elections” immediately preceding a general election would ONLY receive ballots for that one general election. In that situation, another “All Elections” request would have to be submitted after that general election has taken place, so that a person may receive ballots through the regularly scheduled general election that would occur two years later.

Voter's Lake County Residence Address

* Street address

Apartment, lot, or unit number

* City

* Zipcode

Mail Ballot To

Ballots cannot be forwarded.

Required only if different from address above.

Street address

Apartment, lot, or unit number

City

State

Zipcode

Absent Uniformed Services Voter or Overseas Voter

If member of military (including eligible spouse and dependents) or living overseas, then please designate your preferred method for absentee ballot receipt using one of the check boxes provided below. A voted ballot must be returned via standard mail or facsimile (fax) machine transmission. A voted ballot cannot be returned via email and any ballot received via facsimile (fax) machine transmission will not be a secret ballot.

Mail (indicate mailing address within 'Mail Ballots To' section; located above)
E-mail (e-mail address previously provided at the top of this form)
Fax