Registrar of Voters

All fields with an asterisk () are required.*
_____________________________________

Name as Registered *

First Name

Middle Name

Last Name

_____________________________________

Date of Birth *

Birth Date

_____________________________________

Residence Address *

Number and Street

City

ZIP

_____________________________________

Mailing Address

If different from Residence Address.

Number and Street

City

State

ZIP

Country

_____________________________________

Email Address

_____________________________________

Authorization *

To confirm your identity, please select one of the following

California Driver License or Identification Card Number

Last Four Digits of Social Security Number

Ballot Application Acknowledgement

I am requesting a ballot for the upcoming election.

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 ballot for this election by any other means.

_____________________________________

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To apply for a ballot you must be Registered to Vote.
Check your status or Register to Vote with the links below.

Online Ballot Application

All fields with an asterisk () are required.*
_____________________________________

Name as Registered *

_____________________________________

Date of Birth *

_____________________________________

Residence Address *

_____________________________________

Mailing Address

_____________________________________

Email Address

_____________________________________

Authorization *

_____________________________________

To show that you are not a robot please enter the code you see below.

To apply for a ballot you must be Registered to Vote.Check your status or Register to Vote with the links below.

Online Ballot Application

All fields with an asterisk (*) are required._____________________________________

Name as Registered *

_____________________________________

Date of Birth *

_____________________________________

Residence Address *

_____________________________________

Mailing Address

_____________________________________

Email Address

_____________________________________

Authorization *

_____________________________________

To show that you are not a robot please enter the code you see below.

To apply for a ballot you must be Registered to Vote.
Check your status or Register to Vote with the links below.

All fields with an asterisk () are required.*
_____________________________________