Fillable Form 2: Voter Registration and Absentee Ballot Request (County of Campbell)

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Form 2: Voter Registration and Absentee Ballot Request (County of Campbell)

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The Form 2: Voter Registration and Absentee Ballot Request (County of Campbell) form is 1 page long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for County of Campbell

BROWSE COUNTY OF CAMPBELL (VA) FORMS

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Your State may require you to specify a political party to vote in primary elections:
Email
County
Previous name (if applicable)
5
7
Identication
Some States require your
full SSN. Check your State’s
pages in the Voting Assistance
Guide on F VA P.go v.
Contact
information
Include international
prexes. No DSN numbers.
Ballot receipt
2
6
4
Last name
First name
Suf x
Apt. #
3
Legal name
City/Town/Village
Street Address (not P.O. Box)
Voting residence
address
Usually your last U.S.
residence or your legal U.S.
residence. See instructions.
Where to send my
ballot
This is your current mailing
address and should be
different from above. If
required, place a forwarding
address in Box 9.
8
9
This information is for of cial use only. Any unauthorized release may be punishable by law. PREVIOUS EDITIONS ARE OBSOLETE.
Please print in black ink.
1
Classication
Make only 1 selection.
(In most States, you must be
absent from your voting district
to use this form).
I am an activated National Guard member on State orders.
I prefer to receive my ballot, as permitted by my State, by:
I am a member of the Uniformed Services or Merchant Marine on active duty OR
Standard Form 76 (Rev. 08-2013), OMB No. 0704- 0503
Birth date
D D
/ /
M M Y Y Y Y
Additional
requirements
for your State
Such as: mail forwarding
address, additional email
address/phone number,
or other State required
information. See Voting
Assistance Guide.
/ /
You must sign and send in.
Afrmation (REQUIRED): I swear or afrm, 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 disqualied 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.
Witness signature / date if required by your State.
Middle name
I am an eligible spouse or dependent.
Email/Online
Telephone
Fax
State
Zip Code
OR Social Security Number
State Driver’s License or ID
Mail Fax
–
Signature
Date
For any questions about this form, consult the Voting
Assistance Guide available in hard copy or on
F VA P. go v or your Voting Assistance Ofcer.
Race
I am a U.S. citizen residing outside the United States, and my return is not certain.
I am a U.S. citizen residing outside the United States, and I intend to return.
I request an absentee ballot for all elections in which I am eligible to vote AND:
I am a U.S. citizen and have never resided in the United States.
Signature
M M
D D Y Y Y Y
Today’s date
Sex
M F
Political party
Rank from 1-3 in order of preference; be sure appropriate contact information is provided above.
X
For absent Uniformed Service members, their families, and citizens residing outside the U.S.
Voter Registration and Absentee Ballot Request
Federal Post Card Application (FPCA)
See instructions
–
–
Instructions for Federal Post Card Application
Voter Registration and Absentee Ballot Request
The gray numbers and instructions below correspond to the gray numbered boxes on the face of the form.
1
Theclassicationyouchoosemaydetermineinwhichelection(s)youwillbeallowedtovote.Choosethe
one that best represents your current situation.
2
Ifyouwanttovoteinprimaryelections,mostStatesrequireyoutospecifyapoliticalparty.Checkyour
State’spagesintheVotingAssistanceGuideonFVAP.govtoseeifyourStaterequiresyoutospecifya
political party.
3
The information you enter for your name should match the information you normally put on legal or
ofcialforms.Forexample,itshouldbethesamenamethatappearsonyourDriver’sLicenseorother
government-issuedID.
4
While mostStatesallowyoutoentereitheryourDriver’sLicensenumberorthelast4digitsofyourSocial
SecurityNumber,somewillinvalidatethisformwithoutyourfullSSN.CheckyourState’spagesinthe
VotingAssistanceGuideonFVAP.govtoseeifyourStaterequiresthefullSSN.Also,manyStatesaskthat
youprovideyourraceorethnicgroupinordertodemonstratethattheyarecomplyingwiththeVotingRights
ActandtheNationalVoterRegistrationAct.
5
Iftherearequestionsorproblemswithyourform,localelectionofcialswillusethisinformationtocontact
you.Anemailaddressisthesimplestandfastestwayforthemtodoso.Yourvotingmaterialswillbesentto
theemailaddressthatyouprovidehereifyourequestitandyourStateallowsit.Includeanalternateemail
or phone number in Box 9 if necessary.
6
Indicateyourpreferredmethodforreceivingyourballotbyrankingeachbox1,2,or3.AllStatesand
jurisdictionsmustsendabsenteeballotstomilitaryandoverseasvotersbyatleastoneofthefollowing:
email,onlinedownload,orfaxifrequested.CheckyourState’spagesintheVotingAssistanceGuideon
FVAP.govtolearnwhatyourStateallows.Youcanalwaysgetyourabsenteeballotbymail.
7
Thisdeterminesthejurisdictionwhereyouvote.FormilitaryvotersthevotingaddressisyourlegalU.S.
residence.ForoverseascitizensthisisusuallytheU.S.addresswhereyoulastlived.Youdonotneedto
haveanycurrentphysicaltiestothisaddress. Donotuseapostofceboxnumber.Iftheareahasnostreet
names,entertheroutenumberandboxnumber.
8
Entertheaddresswhereyouwantvotingmaterialstobesent.Votingmaterialswillbesenttothisaddress
unless you enter a forwarding address in Box 9.
9
Enteranythingherethatwouldhelpensurethatyourballotisaccepted.CheckyourState’spagesinthe
VotingAssistanceGuideonFVAP.govforanythingyourStatemayspecicallyrequirehere.Forexample,
someStatesrequirelastdateofresidencyintheU.S.,previouslocationofregistration,overseasemployer,
orwitnessaddress.Ifyouwantyourvotingmaterialstobesentsomewhereotherthanwhereyoulivenow,
enterthatalternate(forwarding)addresshere.Provideanalternateemailaddressandphonenumberhere.
AfrmationReadthiscarefully.Itiswhatyouareagreeingtounderoathandpenaltyofperjurybyllingoutand
sendinginthisform.SomeStatesrequirethatyourformbewitnessed.ChecktheVotingAssistanceGuide
onFVAP.govforyourState’srequirements.
From
(Yournameandcurrentcompletemilitaryoroverseasmailingaddress)
To
(YourlocalelectionofceintheUnitedStates.CheckyourState’spagesintheVoting
AssistanceGuideonFVAP.govforcontactinformation.)
International airmail postage is required if not mailed in the
U.S.PostalSer vice,APO/FPOsystem,ordiplomaticpouch.
U.S.PostagePaid
39USC3406
OFFICIALABSENTEEBALLOTINGMATERIAL–FIRSTCLASSMAIL
PARAVION
NOPOSTAGENECESSARYINTHEU.S.MAIL–DMM703.8.0
PrivacyActStatement
Authority:Theauthorit ytocollectyourpersonalinformationonthis
formcomesfrom42USC1973f f,“UniformedandOverseasCitizens
AbsenteeVotingAct(UOCAVA).”
PrincipalPurpose:Thisformservesasanapplicationforregistration
and/orrequestfor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ofcial.
Disclosure:Yourdisclosureofpersonalinformationis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.
Foranyquestionsaboutthisform,consultthe Voting
AssistanceGuideavailableinhardcopyoron
F VA P. go v oryourVotingAssistanceOfcer.
StandardForm76(Rev.08 -2013)
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,andcompletingandreviewingthecollectionofinformation.
Sendcommentsregardingthisburdenestimateoranyother
aspectofthiscollectionofinformation,includingsuggestionsfor
reducingtheburden,totheDepartmentofDefense,Washington
HeadquartersServices,ExecutiveServicesDirectorate,Information
ManagementDivision,4800MarkCenterDrive,EastTower,Suite
02G09,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penalt yforfailingto
comply with a collection of information if it does not display a currently
validOMBcontrolnumber.PLEASEDONOTRETURNYOUR
COMPLETEDFORMTOTHEADDRESSABOVE.
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Form 2: Voter Registration and Absentee Ballot Request (County of Campbell)

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Completed 17 July 2020

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