Vote by Mail Application

FOR OFFICIAL USE ONLY
California Vote-By-Mail Ballot Application

REV 11/2019
Enter the date of the election and the type of election (e.g., Primary, General, or Special). This application must be received by your county elec-
tions official not later than seven (7) days prior to the date of the election. The date of the election can be found at www.sos.ca.gov/elections/
upcoming-elections/. A ballot will not be sent to you if this application is incomplete or inaccurate.
1. THIS IS AN APPLICATION FOR A VOTE-BY-MAIL BALLOT FOR THE , ELECTION.

Month/Day/Year Type of Election (Primary, General, or Special)
2. PRINT NAME: 3. DATE OF BIRTH:

First Middle or Initial Last Month/Day/Year
4. RESIDENCE ADDRESS:
Number and Street (P.O. Box, Rural Route, etc. will not be accepted) (Designate N, S, E, W if used)
City Zip Code California County
5. MAILING ADDRESS FOR BALLOT (IF DIFFERENT FROM ABOVE):

If your mailing address is outside of the U.S., and you are a military or overseas voter, re-register at RegisterToVote.ca.gov or use the Federal
Post Card Application at www.fvap.gov.
Number and Street/P.O. Box (Designate N, S, E, W if used)
City State or Foreign Country Zip Code or Postal Code
6. TELEPHONE NUMBER (OPTIONAL):

Day Evening
7. I WANT TO REQUEST A POLITICAL PARTY BALLOT FOR THE PRESIDENTIAL PRIMARY ELECTION.
I am registered with No Party Preference and want to request a political party ballot for the March 3, 2020, Presidential Primary Election
for the following party:
American Independent Democratic Libertarian
The above political parties are allowing No Party Preference voters to vote their party’s presidential ballot for the upcoming
March 3, 2020, Presidential Primary Election.
8. YES, I WANT TO BECOME A PERMANENT VOTE-BY-MAIL VOTER.

By checking this box and by initialing here , I am requesting to become a permanent vote-by-mail voter. A vote-by-mail ballot
will automatically be sent to me in all future elections. I understand that if I fail to vote by mail in four consecutive statewide general
elections, I will need to reapply for permanent vote-by-mail voter status.
9. THIS APPLICATION MUST BE SIGNED.

I have not applied for a vote-by-mail ballot from any other jurisdiction for this election. I certify under penalty of perjury under the laws of the
State of California that the information I have provided on this application is true and correct.
SIGNATURE DATE
Warning: Perjury is a felony, punishable by imprisonment in state prison for up to four years. (Penal Code § 126)
NOTICE
You have the right to mail or deliver this application directly to your county elections official.
Returning this application to anyone other than your county elections official may cause a delay that could interfere with your ability to vote.
If this application is returned by mail, it must be returned directly to your county elections official.
Only the registered voter himself or herself may apply for a vote-by-mail ballot. An application for a vote-by-mail ballot made by a person other
than the registered voter is a criminal offense.
INDIVIDUALS/ORGANIZATIONS/GROUPS DISTRIBUTING THIS APPLICATION

The format used on this application must be followed by anyone distributing vote-by-mail ballot applications. Failure to conform to this format is
a crime. Anyone distributing this application may not preprint a mailing address in Item 5.
Anyone providing this application to a voter must enter their name, address, and telephone number here:
WHO CAN USE THIS APPLICATION political party must be completed by the voter.If you choose
not to request a political party ballot in the Presidential
The uniform California Vote-By-Mail Ballot Application can only Primary Election, you will be provided a nonpartisan
be used by a registered voter. If you have not already registered ballot containing only the names of candidates for voter-
to vote, you can register to vote online on the Secretary of nominated and nonpartisan offices (this does not include
State’s website at RegisterToVote.ca.gov. You may also pick presidential candidates) and measures, if any, to be voted for
up a Voter Registration Card at your county elections office, at the Presidential Primary Election.
library, or U.S. Post Office. Your completed Voter Registration
Card must be submitted online or to your county elections ITEM 8. Any registered voter may receive a vote-by-mail
office at least 15 days before the election. ballot automatically in all future elections by checking the
Permanent Vote-By-Mail Voter box and initialing the line. Any
To vote by mail, you can use this Vote-By-Mail Ballot voter can opt out of the permanent vote-by-mail status at
Application, use the form in the county voter information guide any time by contacting their county elections official directly.
you receive in the mail before an election, or contact your
county elections office. County contact information can be ITEM 9. Sign and date in this order – month, day, year. No
found online at www.sos.ca.gov/elections/ voting-resources/ witness or notary required.
county-elections-offices/.
HOW TO SUBMIT THE APPLICATION
This Vote-By-Mail Ballot Application is provided by the
Secretary of State (SOS) for use by any person, group, or Your Vote-By-Mail Ballot Application must be returned to your
organization distributing vote-by-mail ballot applications for county elections official at least 7 days before the election.
elections that involve more than one county. For organizations However, if you become ill or disabled during the final week
distributing applications for elections that involve a single before an election, or find that you will be unable to go to
county, the county elections office should be contacted for the your polling place on Election Day, you may request that a
appropriate application format and barcode information. vote-by-mail ballot be delivered to you by submitting a written
statement, signed under penalty of perjury to your county
Californians who are serving in the military and are absent elections official. The statement must contain your name and
from the county where they are eligible to vote, and residence address, the address to which you want the ballot
Californians living or studying abroad may register as a military sent, the name and date of the election in which you would
or overseas voter, either online at RegisterToVote.ca.gov or via like to vote, your signature, and the date. You may authorize
the Federal Post Card Application (FPCA). Doing so provides another person to receive the ballot from the elections official,
more options for receiving your ballot and ensures priority and/or return the ballot to an elections official after you have
service. The FPCA and other important information for military voted it.
and overseas voters is available at www.fvap.gov.
How to Fill Out this Application If this application is returned by mail, it must be returned
directly to your county elections official.
ITEM 1. Enter the date of the election in which you wish to
vote (month, day, year), and the type of election (Primary, Please do not send applications to the SOS’s office. Doing so
General, or Special). will delay the application process.
ITEM 2. Print your first, middle, and last names as they You can find the address and telephone number of your county
appear on your Voter Registration Card. elections official on the SOS website at www.sos.ca.gov/
elections/voting-resources/county-elections-offices/.
ITEM 3. Print your date of birth in this order – month, day,
year. WHAT CAN BE PREPRINTED ON THE APPLICATION
ITEM 4. Print the complete street address of your voting State law requires the voter to personally affix his or her
residence. A post office box or rural route cannot be signature and the address to which the ballot is to be mailed.
accepted.
If an organization is distributing the application, the name,
ITEM 5. Mailing address information must be completed address, and telephone number of the organization authorizing
by the voter. Print the complete address where you want distribution must be included on the application.
your ballot sent if it is different than the residence address
provided in Item 4. In order to ensure accuracy, each voter should fill out all of the
information on the application. However, any person, group,
ITEM 6. Print your telephone number (optional, not or organization distributing the application may preprint the
required) to allow the elections office to contact you if more following:
information is needed.
• The printed name and home address of the voter as it
ITEM 7. Only complete Item 7 if the application is for a appears on the Voter Registration Card.
Presidential Primary Election and you did not choose a • The name and date of the election for which the ballot is
political party preference when you registered to vote. If you requested.
did not choose a preference for a political party when you • The name, address, and telephone number of the person,
registered to vote, you are considered a No Party Preference group, or organization authorizing distribution of the
voter and may request a party’s presidential ballot if that application.
political party allows it. The check off box and name of the
(Revised May 2019)

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FOR OFFICIAL USE ONLY

California Vote-By-Mail Ballot Application

1. THIS IS AN APPLICATION FOR A VOTE-BY-MAIL BALLOT FOR THE , ELECTION.

2. PRINT NAME: 3. DATE OF BIRTH:

City Zip Code California County

5. MAILING ADDRESS FOR BALLOT (IF DIFFERENT FROM ABOVE):

Number and Street/P.O. Box (Designate N, S, E, W if used)

City State or Foreign Country Zip Code or Postal Code

6. TELEPHONE NUMBER (OPTIONAL):

8. YES, I WANT TO BECOME A PERMANENT VOTE-BY-MAIL VOTER.

9. THIS APPLICATION MUST BE SIGNED.

INDIVIDUALS/ORGANIZATIONS/GROUPS DISTRIBUTING THIS APPLICATION

(Revised May 2019)

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