Fillable Form 1: Voter Registration and Absentee Ballot Request (Mississippi)

Fill Online, Printable, Fillable, Blank Form 1: Voter Registration and Absentee Ballot Request (Mississippi) Form

Use Fill to complete blank online MISSISSIPPI pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Form 1: Voter Registration and Absentee Ballot Request (Mississippi)

On average this form takes 12 minutes to complete

The Form 1: Voter Registration and Absentee Ballot Request (Mississippi) form is 2 pages long and contains:

  • 0 signatures
  • 11 check-boxes
  • 42 other fields

Country of origin: US
File type: PDF

BROWSE MISSISSIPPI FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
/ /
Voter Registration and
Absentee Ballot Request
Federal Post Card Application (FPCA)
Print clearly in blue or black ink.
T
h
i
s f
o
rm
i
s f
o
r
absent Uniformed Service
members,
t
he
i
r
families, a
nd c
itize
ns
residing o
u
t
s
i
de
t
he United
S
tat
es.
It
i
s used
to
register to
vot
e,
request
an
absentee ballot
,
a
nd
update yo
ur c
o
n
ta
c
t
information.
See
yo
ur S
tat
e’s
instructions at
FVAP.gov.
1
. Wh
o
a
re
yo
u
?
Pi
c
k
one.
I request an absentee
ballot for all elections
in which I am eligible
to vote AND:
I am on active duty in the Uniformed Services or Merchant Marine -OR- I am an eligible spouse or dependent
.
I am an activated National Guard member on State orders.
I am a U.S. citizen living outside the country, and I intend to return.
I am a U.S. citizen living outside the country, and my return is uncertain.
I am a U.S. citizen living outside the country, and I have never lived in the United States.
Last name
Suffix (Jr., II)
Sex
Female
Male
First name
Previous names (if applicable)
Middle name
Birth date (MM/DD/YYYY)
/ /
Social Security Number
Driver’s license or State ID #
2
. Wh
at
i
s
yo
ur
a
ddress
i
n
t
he U.S. S
tat
e
o
r
t
err
ito
r
y
where
yo
u
a
re
registering to
vot
e
a
nd
requesting a
n
a
bsen
t
ee ballot?
Your voting materials will not be sent to this address. See instructions on other side of form.
Street address Apt #
City, town, village
County
ZIP
3
. Where
a
re
yo
u n
o
w
?
Yo
u mus
t
g
iv
e
yo
ur
C
URRE
NT
a
ddress
to
rece
iv
e
yo
ur
voti
ng materials.
Your mailing address. (Different from above) Your mail forwarding address. (If applicable)
4
. Wh
at
i
s
yo
ur c
o
n
ta
c
t
i
nf
o
rm
atio
n
?
T
h
i
s
i
s s
o
e
l
ec
tio
n
o
ff
i
c
ial
s c
a
n re
a
ch
yo
u
a
b
o
u
t
yo
ur request.
Provide the country code and area code with your phone and fax number. Do not use a Defense Switched Network (DSN) number.
Email: Phone:
Alternate email: Fax:
5
. Wh
at
i
s
yo
ur
voti
ng
preference? Sel
ec
t
One.
How do you want to
receive voting materials
from your election office?
Mail
Email or online
Fax
What is your political party
for primary elections?
6
. W
hat
a
dd
itio
na
l
i
nf
o
rm
atio
n mus
t
yo
u provide?
The following need more information: Alaska, Arizona, Puerto Rico, Vermont, and Virginia. (Ex. Proof of residency, employer, etc.)
You may also use this space to clarify your voter information. See the Voting Assistance Guide at FVAP.gov.
7
.
Yo
u mus
t
re
a
d
a
nd s
i
gn
t
h
i
s statement.
I swear or affirm, under penalty of perjury, that:
The information on this form is true, accurate, and complete to the best of my knowledge. I understand that a material misstatement of fact in
completion of this document may constitute grounds for conviction of perjury.
I am a U.S. citizen, at least 18 years of age (or will be by the day of the election), eligible to vote in the requested jurisdiction, and
I am not disqualified to vote due to having been convicted of a felony or other disqualifying offense, nor have I been adjudicated mentally
incompetent; or if so, my voting rights have been reinstated; and
I am not registering, requesting a ballot, or voting in any other jurisdiction in the United States, except the jurisdiction cited in this voting form.
S
i
gn here
X
To
da
y
’s
dat
e
(
MM
/DD/
YYYY
)
This is a Mississippi specific version of the Federal Post Card
Application (FPCA) which allows for the electronic signature of the
voter by typing his or her name in the bottom blank. The FPCA is for
absent Uniformed Service members, their families, and citizens
residing outside the United States. It is used to register to vote,
request an absentee ballot, and update your contact information.
More instructions on how to fill out this Mississippi UOCAVA FPCA
can be found at www.yallvote.sos.ms.gov.
You can vote wherever you are.
1. Fill out your form completely and accurately.
• Your U.S. address is used to determine where you are eligible to vote
absentee. For military voters, it is usually your last address in your
State of legal residence. For overseas citizens, it is usually the last
place you lived before moving overseas. You do not need to have any
current ties with this address. DO NOT write a PO Box # in section 2.
• Most States allow you to provide a Driver’s License number or the last
4 digits of your SSN. Some States require a full SSN. See your State’s
guidelines at FVAP.gov.
• Most States require you to specify a political party to vote in primary
elections. This information may be used to register you with a party.
• We recommend that you complete this form every year while you are
an absentee voter.
2. Remember to sign this form!
3
. Remove the adhesive liner from the top and sides.
Fold and seal tightly.
• You can find the address for your election office at FVAP.gov.
• All States accept this form by mail, but they vary on email and fax.
See your State’s rules in the Voting Assistance Guide at
FVA
P
.gov.
Questions? Email
vot
e
@
f
va
p.
gov
From
(Your name and mailing address)
Agency Disclosure Statement
The public reporting burden for this collection of
information is estimated to average 15 minutes
per response, including the time for reviewing
instructions, gathering and maintaining the
data needed, and completing and reviewing the
collection of information. Send comments regarding
this burden estimate or any other aspect of this
collection of information, including suggestions for
reducing the burden to: Department of Defense,
Washington Headquarters Services, Executive
Services Directorate, Information Management
Division, 4800 Mark Center Dr., East Tower, Suite
03F09, Alexandria, VA 22350-3100. [OMB Control
#0704-0503]. Respondents should be aware that
notwithstanding any other provision of law, no
person shall be subject to any penalty for failing
to comply with a collection of information if it does
not display a currently valid OMB control number.
DO NOT RETURN YOUR FORM TO THE ADDRESS
ABOVE.
Privacy Act Statement
Authority: The authority to collect your personal
information on this form comes from 52 U.S.C. §
20301, “Uniformed and Overseas Citizens Absentee
Voting Act (UOCAVA).”
Principal purpose: This form serves as an
application for registration and/or request for an
absentee ballot for all persons covered by UOCAVA.
Routine use(s): There is no retention of this
information by the Federal government. Completed
forms are sent by you to an appropriate State
election official.
Disclosure: Your disclosure of personal information
is voluntary. However, failure to provide the
requested personal information may keep the
pertinent jurisdiction from processing this request
and may prevent you from voting absentee.
U.S. Postage P
a
id
39 USC
3406
PAR
AVI
ON
International airmail postage is required if not mailed using the
U.S. Postal Service, APO/FPO/DPO system, or diplomatic pouch.
OFFICIAL ABSENTEE BALLOTING MATERIAL – FIRST CLASS MAIL
NO POSTAGE NECESSARY IN THE U.S. MAIL – DMM 703.8.0
To
(Fill in the address of your election office.
The address can be found online at FVAP.gov.)
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Form 1: Voter Registration and Absentee Ballot Request (Mississippi)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 18 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document