2020 Vote by Mail Application
William Francis Galvin
Secretary of the Commonwealth
Address of Voter Registration:
Date of Birth: Telephone Number:
Mail my November 3
ballot to me at:
Voter required assistance in completing application due to physical disability.
Assisting person's name:
Assisting person's address:
Signed (under penalty of perjury): Date:
Any registered voter may use this application to request a November 3, 2020 mail-in ballot.
Completing the Application
1. Voter Information – Provide your name, the address where you are registered to vote, and date of birth.
Telephone number and e-mail address are optional.
2. Ballot Information – Provide the address where you want your ballot mailed.
3. Assistance – If you are assisting a voter in completing this application, complete this section.
4. Sign your name – If you require assistance in signing the application, you may authorize someone to sign your
name in your presence. That person must complete the assisting person’s information in Section 3.
Submitting the Application
Send the completed application to the local election ofcial at your city or town hall.
Find contact information for local election ofcials at www.sec.state.ma.us/ele or by calling 1-800-462-VOTE (8683).
Applications can be mailed or hand-delivered. Applications may also be submitted electronically by fax or e-mail, as
long as your signature is visible.
The U.S. Postal Service recommends submitting this application no later than October 20 to ensure the timely delivery
of your ballot. A ballot cannot be mailed to you if your application reaches your local election ofce after 5 p.m. on
Ballots must be postmarked by November 3 and delivered to your local election ofce by November 6 in order to be
counted. Ballots that arrive prior to 8 p.m. on November 3 do not require a postmark.