Fillable Voter Registration and Absentee Ballot Request (Federal Voting Assistance Program)

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Voter Registration and Absentee Ballot Request (Federal Voting Assistance Program)

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  • 33 other fields

Country of origin: US
File type: PDF

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Voter Registration and
Absentee Ballot Request
Federal Post Card Application (FPCA)
Print clearly in blue or black ink, please see back for instructions.
This form 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.
See your state’s instructions at FVAP.gov.
1. Who are you? Pick one.
I am on active duty in the Uniformed Services or Merchant Marine -OR- I am an eligible spouse or dependent.
I request an absentee
I am a U.S. citizen living outside the country, and I intend to return.
ballot for all elections
in which I am eligible
I am a U.S. citizen living outside the country, and my intent to return is uncertain.
to vote AND:
I am a U.S. citizen living outside the country, and I have never lived in the United States.
Female
Sex
Last name
Sux (Jr., II)
Male
First name Previous names (if applicable)
Middle name
Birth date (MM/DD/YYYY)
/ /
Social Security Number
Driver’s license or State ID #
Your voting materials will not be sent to this address. See instructions on other side of form.
2. What is your address in the U.S. state or territory where you are registering to vote and requesting an absentee ballot?
Street address Apt #
City, town, village State
County ZIP
3. Where are you now? You MUST give your CURRENT address to receive your voting materials.
Your mailing address. (Dierent from above) Your mail forwarding address. (If dierent from mailing address)
4. What is your contact information? This is so election officials can reach you about your 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. What are your preferences for upcoming elections?
Mail
Email or online
Fax
A. How do you want to receive
voting materials from your
election oce? (Select One)
B. What is your political party
for primary elections?
6. What additional information must you provide?
Puerto Rico and Vermont require more information, see back for instructions. Additional state instructions may be found at FVAP.gov. You
may also use this space to clarify your voter information.
7. You must read and sign this statement.
I s w e a r o r a r m , u n d e r p e n a l t y o f p e r j u r y , t h a t :
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 disqualied to vote due to having been convicted of a felony or other disqualifying oense, 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.
X
Sign here
Today’s date
(MM/DD/YYYY)
/ /
This information is for ocial use only. Any unauthorized release may be punishable by law. Previous editions are obsolete. Standard Form 76 (Rev.04-2019), OMB No. 0704-0503
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.
• If you cannot receive mail at your mailing address, please specify a
mail forwarding address.
• 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.
• Section 6 Requirements: If your voting residence is Vermont, you
must acknowledge the following by writing in section 6: “I swear or
arm that I have taken the Vermont Voter’s Oath.” If your voting
residence is in Puerto Rico, you must list your mother’s and father’s
rst name.
• We recommend that you complete and submit 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. If you printed out the form
yourself you can fold the form and seal it in an envelope.
• You can nd the address for your election oce 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 FVAP.gov.
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 Advisory
When completed, this form contains
personally identiable information and is
protected by the Privacy Act of 1974, as
amended.
Questions?
Email vote@fvap.gov
From
U.S. Postage Paid
(Your name and mailing address)
39 USC 3406
PAR AVION
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 oce.
The address can be found online at FVAP.gov.)
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Voter Registration and Absentee Ballot Request (Federal Voting Assistance Program)

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Completed 19 July 2020

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