2. Complete the following form to receive an early ballot for the August 2, 2022 Primary Election, the November 8, 2022 General Election, or both elections. The last day to request an early ballot be mailed to you is July 22, 2022 for the Primary Election and October 28, 2022 for the General Election.

   Voters on the Active Early Voter List (AEVL) who are not registered with a recognized political party may use this form to request their party ballot choice for the Primary Election.

   Please note that if you are on the Active Early Voter List (AEVL) and registered with the Democratic, Libertarian or Republican party, you do not need to submit this form unless you want your ballot(s) mailed to a different address from what is on your voter registration record.

4. First Name*
5. Last Name*
7. Residence Address (where you live)*
9. City
10. State
11. Zip
13. Date of Birth*
    Date of Birth
14. Last 4 digits of SSN*
15. Email address or Phone number*
19. Mailing Address to Send Ballot (if different from residence)
21. City
22. State
23. Zip
25. Please check appropriate box, if applicable

    1. Temporary mailing address for the selected election(s) only
    2. Please update mailing address on voter record
27. Select the Election(s) for which you would like to receive a ballot:
29. Election*

    1. 2022 Primary Election
    2. 2022 General Election
30. Party Ballot - Primary Election*

    1. Democratic
    2. Republican
    3. City/Town ballot only
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field