2020 STATE ABSENTEE BALLOT REQUEST FORM - INSTRUCTIONS
To request an absentee ballot, a registered voter or voter’s near relative or verifiable legal guardian must complete and sign this
form. If you are not registered to vote in your county of residence, you must register to vote no later than 25 days prior to the date
of the election. You can submit a voter registration form with this request. Prior to completing the form, review the instructions
below.
Voter
Information
Provide your full legal name.
Provide your date of birth.
Provide one of the following:
North Carolina driver license number or non-operator identification card number; or
last four digits of your Social Security number
Provide your current residential address. (Your North Carolina residential address is required so you get the
correct ballot.)
Note: This form will be used to update the above information if it is different from your voter record.
Absentee
Voting
Information
Indicate the election you are requesting an absentee ballot for and the address where you would like your ballot
mailed. Also, indicate if you would like to request absentee ballots for all elections held during this calendar year
in which you are eligible to vote due to continued or expected illness or disability.
Partisan Primary Requests: If you are requesting a by-mail ballot for a partisan primary and you are not affiliated
with a political party, provide your primary ballot preference. You may select a ballot of one of the recognized
political parties that allow unaffiliated voters to participate in their primary or a nonpartisan ballot style. In a given
primary, not all ballot choices may be available. Contact your county board of elections to determine available
ballot options.
Information on Who Can Assist You in Completing this Request Form
All voters: All voters are entitled to assistance from their near relative or verifiable legal guardian. If you are a
near relative or verifiable legal guardian requesting an absentee ballot on behalf of the voter, you must list your
name and address. A near relative is defined as the voter’s:
spouse
parent
grandchild
stepchild
brother
grandparent
mother-in-law
sister
child
father-in-law
Voters Who Are Blind, Disabled, or Unable to Read or Write: If a voter needs assistance in completing the
written request form due to blindness, disability, or inability to read or write and there is not a near relative or legal
guardian available to assist that voter, the voter may request some other person give assistance. If another person
assists in completing the written request form, that person's name and address must be listed on this form.
Voters Who Are Patients in any Hospital, Clinic, Nursing Home, or Rest Home (“Facility): If a registered
voter is a patient in a Facility in North Carolina, a member of a Multipartisan Assistance Team (MAT) authorized
by the county board of elections can assist the voter in completing the request form. Please contact the county
board of elections to request assistance from a MAT. It is unlawful for any owner, manager, director, or employee
of the Facility OTHER than the voter's near relative, verifiable legal guardian, or member of a MAT to request an
absentee ballot on behalf of the voter. If neither the voter’s near relative nor verifiable legal guardian is available,
and a MAT is not available within seven calendar days of a telephonic request for assistance, the voter may obtain
assistance from anyone who is not (1) an owner, manager, director, or employee of the Facility; (2) an elected
official; (3) a candidate; or (4) an officeholder in a political party or a campaign manager or treasurer for a candidate
or political party.
Military &
Overseas
Requests
Complete this section if you are requesting an absentee ballot because you are uniformed services personnel or a
dependent or spouse of uniformed services personnel and
you are absent from your North Carolina county of
residence due to military service. You are also eligible to complete this section if you are a civilian and can claim North
Carolina as your state of residence and you are currently outside of the United States.
Special Note: Military and Overseas voters may email (absentee@ncsbe.gov) or fax (919) 715-0351 a signed
copy of this form.
How to
return this
form
This form must be signed by either the voter or the voter’s near relative/legal guardian.
Absentee request forms may only be returned by the voter, the voter’s near relative or
verifiable legal guardian or a MAT. The form must be delivered in person or by the U.S.
Postal Service or other designated delivery service (DHL, FedEx, or UPS) to the voter’s
county board of elections. Forms may not be faxed or emailed. A completed absentee
request form must be received by the county board of elections not later than
5:00 P.M. on the Tuesday before the election.
Mail to:
Your county board of
elections. Locate the
address on page three of
this form.
X
X
2020 STATE ABSENTEE BALLOT REQUEST FORM
(Read the instructions before completing this form. Items in red are required.)
SBOE 2019.12
FRAUDULENTLY OR FALSELY COMPLETING THIS FORM IS A CLASS I FELONY UNDER CHAPTER 163 OF THE NC GENERAL STATUTES
Voter Information
Last Name
First Name
Middle Name
Suffix
Date of Birth
Previous Last Name Previous First Name
Previous Middle Name
NC DL or ID Number
Last Four Digits of
Social Security number
Current NC Residential Street Address
City State Zip Code County
Have you lived at this address for
30 or more days? Yes
No
If “No”, date moved?
/
/
Provide your mailing address if you do not receive mail at your
residential address.
Absentee Voting Information
Election Date (select one)
3/3/2020 11/3/2020
Select the date of the election event for which a by-mail absentee
ballot is being requested. You may only select one election event per request form.
Mailing City State Zip Code
Absentee Mailing Address (where you would like your ballot sent)
If you are
requesting an absentee ballot for a partisan
primary, DQG\RXDUHQRWDIILOLDWHGZLWKDSROLWLFDO SDUW\
(Unaffiliated), select a primary ballot preference.
Democratic
Libertarian
Republican
Nonpartisan
Near Relative or Legal Guardian Request: If you are requesting an absentee ballot on behalf of a near relative or for someone for whom you are the
legal guardian, provide your name, relationship to the voter (see instructions), address and contact information.
Near Relative or Legal Guardian’s Name Your Relationship to Voter
Address
City
State
Zip Code
Please provide your email address or a telephone number in case we have a question concerning this request.
Voter Assistance: If the voter received assistance completing this form due to blindness, disability, or inability to read or write and no near relative or
legal guardian of the voter was available, list the name and address of the person assisting the voter with completing this form.
Voter Assistant’s Name
Address
City
State
Zip Code
If voter is a patient in a hospital, clinic, nursing home or rest home, does voter need assistance with voting and returning the ballot? Yes No
If Yes, what is the name and address of the hospital or facility?
Military & Overseas
Are you an absentee military or overseas voter? If so, select the best option below that describes your absentee status:
Member of the Uniformed Services or Merchant Marine on active duty or eligible spouse/dependent and currently absent from county of
residence
U.S. citizen outside the United States
Provide the address where you are currently stationed or living overseas.
Send your ballot by mail? (provide address)
Send your ballot by email? (provide email address)
Send your ballot by fax? (provide #)
Voter’s Signature
Near Relative or Legal Guardian Signature (if applicable)
Date
Date
OR
/
/
Check if you would like to request absentee ballots for all 2020 elections
in which you are eligible to vote due to continued or
expected illness or disability.
ALAMANCE
115 SOUTH MAPLE ST
GRAHAM, NC 27253
(336) 570-6755
ALEXANDER
PO BOX 326
TAYLORSVILLE, NC 28681
(828) 632-2990
ALLEGHANY
PO BOX 65
SPARTA, NC 28675
(336) 372-4557
ANSON
PO BOX 768
WADESBORO, NC 28170
(704) 994-3223
ASHE
150 GOVERNMENT CIR, STE 2100
JEFFERSON, NC 28640
(336) 846-5570
AVERY
PO BOX 145
NEWLAND, NC 28657
(828) 733-8282
BEAUFORT
PO BOX 1016
WASHINGTON, NC 27889
(252) 946-2321
BERTIE
PO BOX 312
WINDSOR, NC 27983
(252) 794-5306
BLADEN
PO BOX 512
ELIZABETHTOWN, NC 28337
(910) 862-6951
BRUNSWICK
PO BOX 2
BOLIVIA, NC 28422
(910) 253-2620
BUNCOMBE
PO BOX 7468
ASHEVILLE, NC 28802
(828) 250-4200
BURKE
PO BOX 798
MORGANTON, NC 28680-0798
(828) 764-9010
CABARRUS
PO BOX 1315
CONCORD, NC 28026-1315
(704) 920-2860
CALDWELL
PO BOX 564
LENOIR, NC 28645
(828) 757-1326
CAMDEN
PO BOX 206
CAMDEN, NC 27921-0206
(252) 338-5530
CARTERET
1702 LIVE OAK ST, STE 200
BEAUFORT, NC 28516-1898
(252) 728-8460
CASWELL
PO BOX 698
YANCEYVILLE, NC 27379
(336) 694-4010
CATAWBA
PO BOX 132
NEWTON, NC 28658-0389
(828) 464-2424
CHATHAM
PO BOX 111
PITTSBORO, NC 27312
(919) 545-8500
CHEROKEE
40 PEACHTREE ST
MURPHY, NC 28906
(828) 837-6670
CHOWAN
PO BOX 133
EDENTON, NC 27932
(252) 482-4010
CLAY
54 CHURCH ST
HAYESVILLE, NC 28904
(828) 389-6812
CLEVELAND
PO BOX 1299
SHELBY, NC 281511299
(704) 484-4858
COLUMBUS
PO BOX 37
WHITEVILLE, NC 28472
(910) 640-6609
CRAVEN
406 CRAVEN ST
NEW BERN, NC 28560
(252) 636-6610
CUMBERLAND
227 FOUNTAINHEAD LN, STE 101
FAYETTEVILLE, NC 28301
(910) 678-7733
CURRITUCK
PO BOX 177
CURRITUCK, NC 27929
(252) 232-2525
DARE
PO BOX 1000
MANTEO, NC 27954
(252) 475-5631
DAVIDSON
PO BOX 1084
LEXINGTON, NC 27293-1084
(336) 242-2190
DAVIE
161 POPLAR ST, STE 102
MOCKSVILLE, NC 27028-2225
(336) 753-6072
DUPLIN
PO BOX 975
KENANSVILLE, NC 28349
(910) 296-2170
DURHAM
PO BOX 868
DURHAM, NC 27702
(919) 560-0700
EDGECOMBE
PO BOX 10
TARBORO, NC 27886
(252) 641-7852
FORSYTH
201 N. CHESTNUT ST
WINSTON SALEM, NC 27101-4120
(336) 703-2800
FRANKLIN
PO BOX 180
LOUISBURG, NC 27549
(919) 496-3898
GASTON
PO BOX 1396
GASTONIA, NC 28053
(704) 852-6005
GATES
PO BOX 621
GATESVILLE, NC 27938
(252) 357-1780
GRAHAM
PO BOX 1239
ROBBINSVILLE, NC 28771
(828) 479-7969
GRANVILLE
PO BOX 83
OXFORD, NC 27565-0083
(919) 693-2515
GREENE
110 SE FIRST ST
SNOW HILL, NC 28580
(252) 747-5921
GUILFORD
PO BOX 3427
GREENSBORO, NC 27402
(336) 641-3836
HALIFAX
PO BOX 101
HALIFAX, NC 27839
(252) 583-4391
HARNETT
PO BOX 356
LILLINGTON, NC 27546
(910) 893-7553
HAYWOOD
63 ELMWOOD WAY, STE A
WAYNESVILLE, NC 28786
(828) 452-6633
HENDERSON
PO BOX 2090
HENDERSONVILLE, NC 28793
(828) 697-4970
HERTFORD
PO BOX 355
AHOSKIE, NC 27910
(252) 358-7812
HOKE
PO BOX 1565
RAEFORD, NC 28376-1565
(910) 875-8751
HYDE
PO BOX 152
SWAN QUARTER, NC 27885
(252) 926-4194
IREDELL
203 STOCKTON ST
STATESVILLE, NC 28677
(704) 878-3140
JACKSON
876 SKYLAND DR, STE 1
SYLVA, NC 28779-2705
(828) 586-7538
JOHNSTON
PO BOX 1172
SMITHFIELD, NC 27577
(919) 989-5095
JONES
367-B HWY 58-S
TRENTON, NC 28585
(252) 448-3921
LEE
PO BOX 1443
SANFORD, NC 27331
(919) 718-4646
LENOIR
PO BOX 3503
KINSTON, NC 28502-3503
(252) 523-0636
LINCOLN
451 SALEM CHURCH RD
LINCOLNTON, NC 28092
(704) 736-8480
MACON
5 WEST MAIN ST, FL 1
FRANKLIN, NC 28734
(828) 349-2034
MADISON
PO BOX 142
MARSHALL, NC 28753
(828) 649-3731
MARTIN
PO BOX 801
WILLIAMSTON, NC 27892
(252) 789-4317
MCDOWELL
PO BOX 1509
MARION, NC 28752
(828) 659-0834
MECKLENBURG
PO BOX 31788
CHARLOTTE, NC 28231-1788
(704) 336-2133
MITCHELL
11 N MITCHELL AVE, RM 108
BAKERSVILLE, NC 28705
(828) 688-3101
MONTGOMERY
PO BOX 607
TROY, NC 27371
(910) 572-2024
MOORE
POST OFFICE BOX 787
CARTHAGE, NC 28327
(910) 947-3868
NASH
PO BOX 305
NASHVILLE, NC 27856
(252) 459-1350
NEW HANOVER
230 GOVERNMENT CENTER DR, STE 38
WILMINGTON, NC 28403
(910) 798-7330
NORTHAMPTON
PO BOX 603
JACKSON, NC 27845
(252) 534-5681
ONSLOW
246 GEORGETOWN RD
JACKSONVILLE, NC 28540
(910) 455-4484
ORANGE
PO BOX 220
HILLSBOROUGH, NC 27278
(919) 245-2350
PAMLICO
PO BOX 464
BAYBORO, NC 28515
(252) 745-4821
PASQUOTANK
PO BOX 1797
ELIZABETH CITY, NC 27906
(252) 335-1739
PENDER
PO BOX 1232
BURGAW, NC 28425
(910) 259-1220
PERQUIMANS
PO BOX 336
HERTFORD, NC 27944
(252) 426-5598
PERSON
331 SOUTH MORGAN ST
ROXBORO, NC 27573-5223
(336) 597-1727
PITT
PO BOX 56
GREENVILLE, NC 27835-0056
(252) 902-3300
POLK
PO BOX 253
COLUMBUS, NC 28722
(828) 894-8181
RANDOLPH
1457 N. FAYETTEVILLE ST
ASHEBORO, NC 27203
(336) 318-6900
RICHMOND
PO BOX 1843
ROCKINGHAM, NC 28380
(910) 997-8253
ROBESON
PO BOX 2159
LUMBERTON, NC 28359
(910) 671-3080
ROCKINGHAM
PO BOX 22
WENTWORTH, NC 27375
(336) 342-8107
ROWAN
1935 JAKE ALEXANDER BLVD W, STE D10
SALISBURY, NC 28147
(704) 216-8140
RUTHERFORD
PO BOX 927
RUTHERFORDTON, NC 28139
(828) 287-6030
SAMPSON
120 COUNTY COMPLEX RD, STE 110
CLINTON, NC 28328
(910) 592-5796
SCOTLAND
231 EAST CRONLY ST, STE 305
LAURINBURG, NC 28352
(910) 277-2595
STANLY
PO BOX 1309
ALBEMARLE, NC 28002
(704) 986-3647
STOKES
PO BOX 34
DANBURY, NC 27016
(336) 593-2409
SURRY
PO BOX 372
DOBSON, NC 27017
(336) 401-8225
SWAIN
PO BOX 133
BRYSON CITY, NC 28713
(828) 488-6177
TRANSYLVANIA
PO BOX 868
BREVARD, NC 28712
(828) 884-3114
TYRRELL
PO BOX 449
COLUMBIA, NC 27925
(252) 796-0775
UNION
PO BOX 1106
MONROE, NC 28111-1106
(704) 283-3809
VANCE
300 S. GARNETT ST, STE C
HENDERSON, NC 27536
(252) 492-3730
WAKE
PO BOX 695
RALEIGH, NC 27602-0695
(919) 404-4040
WARREN
PO BOX 803
WARRENTON, NC 27589
(252) 257-2114
WASHINGTON
PO BOX 1007
PLYMOUTH, NC 27962-1007
(252) 793-6017
WATAUGA
PO BOX 528
BOONE, NC 28607
(828) 265-8061
WAYNE
309 E. CHESTNUT ST
GOLDSBORO, NC 27530
(919) 731-1411
WILKES
110 NORTH ST, RM 315
WILKESBORO, NC 28697
(336) 651-7339
WILSON
PO BOX 2121
WILSON, NC 27894-2121
(252) 399-2836
YADKIN
PO BOX 877
YADKINVILLE, NC 27055
(336) 849-7907
YANCEY
PO BOX 763
BURNSVILLE, NC 28714
(828) 682-3950
MAILING ADDRESSES OF COUNTY BOARD OFFICE
S