Emergency Vote-by-Mail Ballot Request

To request an emergency vote-by-mail ballot, simply complete the following form, then print and return it to our office using the instructions provided on the printed form. California law requires that your application be made in person at the Registrar of Voters office, located at 1300 South Grand Avenue, Building C,
Santa Ana.

Untitled Document

Full name:
Date of birth:
Residential address:
City:
Zip Code:
Phone: