Absentee Ballot Request Form

Step 1 of 3: Complete your Application

SECTION 1: FOR MILITARY/OVERSEAS CIVILIAN VOTERS ONLY
I am a member of the military on active duty or their spouse/dependent
I am a US citizen residing overseas and I intend to return
I am a US citizen residing overseas and I do not intend to return
I prefer to receive my ballot by:
Email    Mail    Fax
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SECTION 2: ALL VOTERS
I request an absentee ballot for:
 April 23, 2013 Special Election (application deadline by mail is April 17, 2013)
 All elections for which I am eligible to vote (your name will remain on the permanent absentee voter list unless removed by you)
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Personal Information
First Name*
Middle Name
Last Name*
Suffix
Date of Birth* (mm/dd/yyyy)
Email Address (Optional)
Telephone Number (Optional)
Fax Number (Optional)
Driver's license number or a DMV-issued ID number
Last four numbers of your Social Security Number
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My current residence addresss is:
Street Number*
Street Name* Click to select Street Name
Type Street Name and click select
Quadrant*
Apt. No.
City, State, Zip Code* -
Check here if this is a change of address
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I request ballot(s) to be mailed to the following address (if different from residence address):
Address*
Apt. No.
City*
State/Country*   
Zip (for U.S. addresses)
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Certificate of Assistance
I am unable to sign my application for an absentee ballot without assistance because of a disability or the inability to read or write.
Assistant Information
Full Name*
Address1*
Address2
City*
State*
Zip Code*

 

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Fields marked * are required

DC Board of Elections
441 4th Street, NW, Suite 250 North
Washington, DC 20001
Tel: (202) 727-2525 | TTY: (202) 639-8916 | Tollfree: 1-866-DC-VOTES