2021 Vote by Mail Application
Town of Concord
Voter
Information
Name:
Address of Voter Registration:
1
Date of Birth: Telephone Number:
2
E-mail Address:
Ballot
Information
Mail my March 25
th
ballot to me at:
3
Signature
Signed (under penalty of perjury)
1. Voter Information – Provide your name, the address where you are registered to vote, and date of birth.
2. Ballot Information – Provide the address where you want your ballot mailed.
3. 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 4.
4. Assistance – If you are assisting a voter in completing this application, complete this section.
Applications for the March 25th Town Election are due by 5pm on Friday, March 19 by 5pm.
Submitting the Application
Email a scan or photo to:
townclerk@concordma.gov
OROROROR
Drop off at:
Official Town Drop Box currently located at
1276 Main St:
Harvey Wheeler Community Center
(to the left of the upper level entrance)
Eligibility
Any registered voter may use this application to request a March 25, 2021 Town Election mail-in
ballot.
Completing the Application
Mail to:
Town Clerk
PO Box 535
Concord, MA 01742
OROROROR
4
Assisting person's name:
Assisting person's address:
Assistance
(If applicable)
Voter required assistance in completing application due to physical disability.
Date
