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Vote By Mail Ballot Application
Registered Name




Date of Birth

*
*
*
Residence Address

*
*
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Mailing Address

If different from above.







Vote By Mail Application Acknowledgement*


 
Authorization


 
- OR -

 

By clicking [Apply Electronically], I certify under penalty of perjury under the laws of the State of California that the residence address on this application are true and correct and that I have not applied for a Vote-by-Mail ballot for this election by any other means.