REQUEST FOR MISSOURI MAIL-IN BALLOT
All mail-in ballots must be notarized.
I, , do hereby request a mail-in ballot for the
Election under Section 115.302, RSMo.
For identification purposes: Date of Birth (MM/DD/YY) or last four digits of Social Security number
If this is a primary election, please print the name of the political party ballot you wish to receive:
Address where I am registered to vote:
ity, State, Zip Code)
Address where ballot is to be mailed
(Street Address or PO Box)
(City, State, Zip Code)
(Include Area Code)
I do solemnly swear that all statements made on this application are true to the best of my knowledge and belief.
Signature of Registered Voter Date
Mail this completed form to your local election authority. Addresses can be found on the Missouri Secretary of State’s
website. Missouri law requires that requests for mail-in ballots must be received by 5:00 p.m. on the second Wednesday prior to
Election Day. If you registered by mail and this is your first time voting, you must provide a copy of either: (1) an ID issued by
the Federal Government,
or private) of higher
government document tha
t contains y
§§ 115.277, 115.302, 115.427