Fillable Facsimile Or Electronic Mail Vote Secret Ballot Waiver Form (Oregon)

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Facsimile Or Electronic Mail Vote Secret Ballot Waiver Form (Oregon)

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Facsimile or Electronic Mail Vote Secret Ballot Waiver Form
SEL 531
rev 03/16
ORS 246.021
County Information to be completed by County Elections
Of
ficial
County
Fax Number/Email for returning a completed ballot
Voter Information – please print
Last Name
First Name
Middle Name
Oregon Residence Address
City
State
Zip Code
Home Phone
Work Phone optional
Cellular Phone optional
Fax
Email Address optional
Mailing Address if different than residence address
Country
APO/FPO/DPO
I,
(print name) acknowledge that by casting my voted
Elector’s Signature
Date Signed
The residence address provided is the same as the current Registration and Absentee Ballot Request - FPCA
The ballot facsimile or an electronic mail is received in the office of the county clerk not later than 8pm on the day of the
election:
Is accompanied by a facsimile or an electronic mail scan of the return identification envelope containing the signature of
the elector and
The signature of the elector is verified by the county elections office using the elector’s current registration record.
For Office Use Only
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Facsimile Or Electronic Mail Vote Secret Ballot Waiver Form (Oregon)

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Completed 15 August 2020

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