Registered Voters as of 05/22/2015 Democrat: 553,897 Republican: 238,581 Other: 300,698 Total: 1,093,176

Absentee Ballot Request Form

Notice: If you are an overseas voter or are requesting an absentee ballot for an overseas voter, please use the Overseas Absentee Ballot Request Form.

This request is valid for only one (1) registered voter. If you are a qualified and registered voter, ballots will be mailed only for the elections checked. Absentee ballots are mailed approximately 35 days prior to each election to those voters who have requested an absentee ballot. One request is deemed sufficient for 2 regularly scheduled general elections.

ABSENTEE BALLOTS CANNOT BE FORWARDED. If you will not be at your Broward3 County address, please complete the MAIL BALLOT TO portion of this form with the address to which you want the ballot mailed.

( * Denotes a required field) 

* Are you making this request for someone in your immediate family?
Voter Information:
* Voter's First Name:  
 Voter's Middle Initial:  
*  Voter's Last Name:  
  *  Voter's Birth Date(mm/dd/yyyy):  

*  Broward3 County Residence Address(No PO Box): 

Voter's Apt, Lot, or Unit Number:  
*  Voter's City:  
*  Voter's ZIP Code:  
Voter's Email Address:  
Voter's Daytime Phone:  
Voter ID Number(if available):  
Mail Ballot to: (if different from above)
Street, PO Box, Rural Route: 
Apartment, Lot, or Unit Number: 
ZIP Code: 

Absentee Status:

Absentee ballots requested:

* Individual Elections