Application Form to Vote by Post
Please complete in BLACK INK and BLOCK CAPITALS and return to Blackpool Council, Town Hall,
Blackpool FY1 9SD,. If you need help filling in this form please phone 01253 477490/477161.
5. Address for postal ballot paper(s) 1. Address where you are registered to Vote
My address where I’m registered
to vote
Or
The following address
2. About you
First name(s) (in full)
Surname
Title (Mr, Mrs, Ms, Miss, Dr, Other)
Reason for sending ballot paper(s) to an alternative
address
6. Declaration 3. How long do you want a postal vote for?
I want to vote by post at all elections
(choose only one of the following three
Until further notice :
For the Election(s) to be held on:
For Election(s) until
4. Have you had help completing this form?
Name of helper
As far as I know, the details on this form are true and
accurate. (You
can be fined for making a false
statement on this form.)
Date of Birth
D D M M Y Y Y Y
Signature or reasons unable to sign
Please keep within the box and use BLACK INK.
Date of declaration
Address of helper
For Office Use Only
