Use black ink
Print your name
Please print your name exactly
as you registered to vote.
1
Last name
First name
Jr Sr II Ill IV
Middle name or initial
About you
Phone and email are optional
and used if information is
missing on this form.
2
Birth date
Phone
Email
Your address
Please print your address
exactly as you registered
to vote.
3
Address (not P.O. Box) Apt. number
City/Town State PA Zip code
Municipality County
Ward (if known) Voting district (if known)
I have lived at this address since:
Where to mail
ballot?
4
Same as above Address or P.O. Box
City/Town State Zip code
Identication
If you have a PennDOT number,
you must use it. If not, please
provide the last four digits of
your Social Security number.
See “Necessary Identication”
on Page 2.
5
PA driver's license or PennDOT ID card number
Last four digits of your Social Security number X X X - X X -
I do not have a PA driver’s license or a PennDOT ID card or a Social Security number.
Declaration
6
I declare that I am eligible to vote by mail-in ballot at the forthcoming primary or election; that I am
requesting the ballot of the party with which I am enrolled according to my voter registration record; and
that all of the information which I have listed on this mail-in ballot application is true and correct.
Voter signature here X Date
Annual mail-in
request
See “What is an annual
mail-in ballot request?”
for more information.
7
If you would like to apply to receive mail-in ballots for the remainder of this year and if you would like to
automatically receive an annual application for mail-in ballots each year, please indicate below.
I would like to receive mail-in ballots this year and receive annual applications for mail-in ballots
each year.
Help with this form
Complete this section if you are
unable to sign the declaration
in Section 6.
8
I hereby state that I am unable to sign my application for a mail-in ballot without assistance because I am
unable to write by reason of my illness or physical disability. I have made or have received assistance in
making my mark in lieu of my signature.
Mark of voter X Date
Address of witness
Signature of witness X
DOS-07/2020
Pennsylvania Application for Mail-In Ballot
Page 1
M
Page 2
Pennsylvania Application for Mail-In Ballot
Once your application is completed, you may return it to your local county board of elections. If you’re
unsure of where to mail your application, please visit www.VotesPA.com/county for more information.
How to submit your application:
In order to apply for a mail-in ballot, you must supply your PA Driver’s License or PennDOT issued photo ID card
number in the Identification section. If you do not have a PA Driver’s License or PennDOT issued photo ID card,
you must supply the last four (4) digits of your Social Security number.
If you do not have a valid form of either of these types of identification, please check the box titled “I do not
have a PA driver’s license or a PennDOT ID card or a Social Security number” in the Identification section. If you
choose this option, you must enclose a photocopy of an acceptable ID.
Please visit www.VotesPA.com/MailBallot for more information, call 1-877-VotesPA (1-877-868-3772), or
contact your county board of elections.
Necessary identification:
The deadline to apply for a mail-in ballot is 5:00PM
on the Tuesday before the election. Please note your
application must be received in the county board of
elections office by that time. Postmarks do not count.
The deadline to return your completed ballot is
8:00PM on election day. Please note your completed
ballot must be received in the county board of
elections office by that time. Postmarks do not count.
Deadline alert:
Questions?
Call your County
Election Office
or call 1-877-VOTESPA
(1-877-868-3772).
For more information about
voting, visit our website:
www.VotesPA.com.
Información en español:
Si le interesa obtener este
formulario en español, llame al
1-877-868-3772.
If you indicate you would like to be added to the annual mail-in ballot request list, you will receive an application
to renew your request for mail-in ballot each year. Once your application is approved, you will automatically
receive ballots for the remainder of the year and you do not need to submit an application for each election.
If you update your voter registration due to relocation out of county after you submit an annual mail-in request,
please ensure your annual status is transferred when updating your address.
What is an annual mail-in ballot request?
WARNING: If you receive a mail-in ballot and return your voted ballot by the deadline, you may
not vote at your polling place on election day. If you are unable to return your voted mail-in ballot
by the deadline, you may only vote a provisional ballot at your polling place on election day,
unless you surrender your mail-in ballot and envelope to the judge of elections to be voided to
vote by regular ballot.
DOS-07/2020
County Election Office addresses
Adams
117 Baltimore St
Rm 106
Gettysburg PA 17325
(717) 337-9832
Allegheny
542 Forbes Ave
Ste 609
Pittsburgh PA 15219-2913
(412) 350-4500
Armstrong
Administration Bldg
450 E Market St
Ste 207
Kittanning PA 16201
(724) 548-3222
Beaver
810 Third St
Beaver PA 15009
(724) 770-4440
Bedford
200 S Juliana St
3rd Fl
Ste 301
Bedford PA 15522
(814) 623-4807
Berks
633 Court St
1st Fl
Reading PA 19601
(610) 478-6490
Blair
423 Allegheny St
Ste 043
Hollidaysburg PA 16648-2022
(814) 693-3150
Bradford
6 Court St
Ste 2
Towanda PA 18848
(570) 265-1717
Bucks
55 E Court St
Doylestown PA 18901-4318
(215) 348-6163
Butler
PO Box 1208
Butler PA 16003
(724) 284-5308
Cambria
200 S Center St
Ebensburg PA 15931
(814) 472-1464
Cameron
20 E Fifth St
Emporium PA 15834-1469
(814) 486-9321
Carbon
76 Susquehanna St
PO Box 170
Jim Thorpe PA 18229-0170
(570) 325-4801
Centre
420 Holmes St
Willowbank Office Bldg
Bellefonte PA 16823-1486
(814) 355-6703
Chester
601 Westtown Rd
Ste 150
PO Box 2747
West Chester PA 19380-0990
(610) 344-6410
Clarion
Administrative Building
330 Main St
Rm 104
Clarion PA 16214
(814) 226-4000 Ext 2006
Clearfield
212 E Locust St
Ste 106
Clearfield PA 16830
(814) 765-2642 ext 5053
Clinton
2 Piper Way
Ste 309
Lock Haven PA 17745
(570) 893-4019
Columbia
PO Box 380
Bloomsburg PA 17815-0380
(570) 389-5640
Crawford
903 Diamond Park
Meadville PA 16335
(814) 333-7307
Cumberland
1601 Ritner Highway
Ste 201
Carlisle PA 17013
(717) 240-6385
Dauphin
PO Box 1295
Harrisburg PA 17108-1295
(717) 780-6360
Delaware
Govt Center Bldg
201 W Front St
Media PA 19063-2728
(610) 891-4659
Elk
300 Center St
PO Box 448
Ridgway PA 15853-0448
(814)776-5337
Erie
140 W 6th St
Rm 112
Erie PA 16501
(814) 451-6017
Fayette
22 E Main St
Public Service Bldg
Uniontown PA 15401
(724) 430-1289
Forest
526 Elm St
Box 3
Tionesta PA 16353
(814) 755-3537
Franklin
157 Lincoln Way East
Chambersburg PA 17201-2211
(717) 261-3886
Fulton
116 W Market St
Ste 205
McConnellsburg PA 17233
(717) 485-6872
Greene
93 E High St
Rm 102
Waynesburg PA 15370
(724) 852-5230
Huntingdon
Bailey Building
233 Penn St
Huntingdon PA 16652-1486
(814) 643-3091 Ext 205
Indiana
825 Philadelphia St
Indiana PA 15701-3934
(724) 465-3852
Jefferson
155 Main St
Jefferson Place
Brookville PA 15825-1269
(814) 849-1693
Juniata
1 N Main St
PO Box 68
Mifflintown PA 17059
(717) 436-7706
Lackawanna
123 Wyoming Ave
2nd Floor
Scranton PA 18503
(570) 963-6737
Lancaster
PO Box 2139
Lancaster PA 17608
(717) 299-8293
Lawrence
430 Court St
New Castle PA 16101
(724) 656-2161
Lebanon
400 S 8th St
Municipal Bldg
Rm 209
Lebanon PA 17042
(717) 228-4428
Lehigh
17 S 7th St
Allentown PA 18101-2401
(610) 782-3194
Luzerne
20 N Pennsylvania Ave
Ste 207
Wilkes-Barre PA 18701
(570) 825-1715
Lycoming
48 W Third St
Williamsport PA 17701-9536
(570) 327-2267
McKean
500 W Main St
Smethport PA 16749
(814) 887-3203
Mercer
5 Courthouse
Mercer PA 16137-1227
(724) 662-7542
Mifflin
20 N Wayne St
Lewistown PA 17044
(717) 248-6571
Monroe
One Quaker Plaza
Rm 105
Stroudsburg PA 18360
(570) 517-3165
Montgomery
Voter Services
PO Box 311
Norristown PA 19404-0311
(610) 278-3280
Montour
253 Mill St
Danville PA 17821
(570) 271-3002
Northampton
Elections Division
669 Washington St
Easton PA 18042
(610) 829-6260
Northumberland
320 N 2nd St
Ste 1
Sunbury PA 17801
(570) 988-4208
Perry
PO Box 37
New Bloomfield PA 17068
(717) 582-2131 ext 4110
Philadelphia
City Hall, Room 142
1400 John F Kennedy Blvd
Philadelphia, PA 19107
(215) 686-3469
Pike
506 Broad St
Milford PA 18337
(570) 296-3427
Potter
1 N Main St
Ste 204
Coudersport PA 16915
(814) 274-8467
Schuylkill
420 N Centre St
Pottsville PA 17901
(570) 628-1467
Snyder
PO Box 217
Middleburg PA 17842-0217
(570) 837-4207
Somerset
300 N Center Ave
Ste 340
Somerset PA 15501
(814) 445-1549
Sullivan
245 Muncy St
PO Box 157
Laporte PA 18626
(570) 946-5201 ext 7
Susquehanna
PO Box 218
31 Lake Ave
Montrose PA 18801
(570) 278-6697
Tioga
118 Main St
Wellsboro PA 16901
(570) 723-8230
Union
155 N 15th St
Lewisburg PA 17837-8822
(570) 524-8681
Venango
1174 Elk St
PO Box 831
Franklin PA 16323-0831
(814) 432-9514
Warren
204 4th Ave
Warren PA 16365
(814) 728-3406
Washington
100 W Beau St
Rm 206
Washington PA 15301
(724) 228-6750
Wayne
925 Court St
Honesdale PA 18431
(570) 253-5978
Westmoreland
2 N Main St
Ste 109
Greensburg PA 15601
(724) 830-3150
Wyoming
1 Courthouse Sq
Tunkhannock PA 18657
(570) 996-2226
York
28 E Market St
York PA 17401-1579
(717) 771-9604
For a listing of available
email addresses, go to
www.votesPA.com/county.
DOS-07/2020