’-
-(can be found on Voter Idencaon Card):
FOR OFFICE USE ONLY
*Indicates required informaon
Middle
Sux
You must be registered to vote in the county to receive an absentee ballot. If you are registered to vote in the county, this form will be used to update
your voter registraon if the informaon provided on this form is dierent than the informaon on your registraon record.
Home Street Address (include apt, lot, etc. if applicable)
City Zip County
If dierent than above
Mailing Address/P.O. Box
Phone
Email
General Primary
School
City Special:
Do not add this contact
info to my voter record
Elecon
Check one polical party
Democrac Libertarian Republican
Powers of aorney do not
have legal authority to
request an absentee ballot
on behalf of another.
I swear or arm that I am the person named above and I am a registered voter or I am entled to register at the address listed on this form.
I am eligible to receive and vote an absentee ballot for the elecon indicated above.
City State Zip
Country (other than USA)
Date of Birth (month, day, year)
First
Last
/ /
/
/
Important
Voters without an Iowa Driver’s License or Non-Operator ID number are mailed an Iowa Voter Idencaon Card at the me of registraon.
Choose only elecon.
Complete the section below if you are a person soliciting absentee ballot request forms on behalf of a political party, candidate, or committee as defined by Iowa Code
Chapter 68A and are using this form as a receipt. This section is not part of the official absentee ballot request form.
RECEIPT FOR ABSENTEE BALLOT REQUEST
This receipt should be left with the voter requesting the ballot.
Voter’s Name
Election Type or Date General Primary School City Special:
OR Election Date: / /
Name of Political Agent
Phone Number of Political Agent
Political Party, Candidate, or Committee
Date and Time Request Received by Agent
NOTICE TO VOTER
You have requested an absentee ballot. This form was given to you by a person (agent) who is working with a political party, candidate, or committee. The person may also be
working for a committee working to pass or defeat a question on the ballot. The county auditor will mail your ballot to you.
Request forms solicited by a political party, candidate or committee as defined by Iowa Code chapter 68A are required by Iowa law to be delivered to the appropriate
county auditor’s office within 72 hours of the date and time this request form was received by the soliciting agent or by 5 p.m. on the absentee mailing deadline before the
election, whichever is earlier.
The county auditor will mail you a ballot within 24 hours of receiving your request or within 24 hours of when the ballots are available. Ballots for primary and general
elections are available 40 days before the election. Questions regarding this receipt should be directed to the political contact number listed above. Questions concerning your
ballot should be directed to your county auditor.
