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Permanent Absent Voter List Request

2. PERMANENT ABSENT VOTER LIST REQUEST
   Please add me to the permanent absent voter list so I will automatically receive absentee applications in the mail before every election.

   Please add me to the permanent absent voter list so I will automatically receive absentee applications in the mail before every election.

4. Name- First

5. MI

6. Last

8. Address

10. City

11. State

12. Zip Code

14. Birth Year

16. Phone Number

18. Email Address

Leave This Blank:


20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

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