-













  







 





 Date:













  







-










-
Instructions:
Complete fillable Absentee Ballot Request Form
Print form
Sign and date
Place in an envelope
and mail to:
o Scott County Auditor
Attn: Absentee Request Form
600 W 4th St.
Davenport, Iowa 52801-1003
Questions? Please call us
at 563-326-8631.