Absentee Ballot Request Form
for Lake County Residents
Voter's Personal Information
*
First name
Middle name
*
Last name
*
Date of birth
*
E-mail address
*
Daytime phone number
Voter ID number (if available)
Requested Election(s)
All Elections*
or
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 two regularly scheduled general elections. This would mean that a person selecting "ALL ELECTIONS" prior to the November 4th, 2008 General election will be automatically scheduled to receive ballots for all elections through the 2010 General election.
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
Please choose
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District of Columbia
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Idaho
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Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
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Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zipcode