2022 Vote By Mail Application

Source page 1

William Francis Galvin
2022 Vote by Mail Application                                                           Secretary of the Commonwealth


              1               Name:
Voter Information
                              Address of Voter Registration:


                              Date of Birth:_____________ Phone Number (optional):___________________

                              E-mail Address (optional):____________________________________________

              2                   Elections:                                  * Primary Ballot
                                         All 2022 Elections*                          Democratic
Ballot Information
                                         Sept. 6th State Primary Only*                Republican
                                         Nov. 8th State Election Only


                              Ballot Mailing Address_______________________________________________

              3                   Voter required assistance in completing application due to physical disability.
Assistance
                                    Assisting person’s name:_________________________________________

                                    Assisting person’s address:_______________________________________

                                  This application is being made by a family member

                                     Relationship to Voter:_________________________________________


        Signed (under penalty of perjury):                                                         Date:
Eligibility
Any registered voter may use this application to request a mail-in ballot for any 2022 election.

Completing the Application
1.   Voter Information - Provide your name, the address where you are registered to vote, and date of birth.
2.   Ballot Information - Choose which ballot(s) you want to receive by mail. If you’re requesting a primary ballot and
     you’re not registered in a party, you must pick a primary ballot. Provide your ballot mailing address.
3.   Assistance - If you’re helping someone complete this application, or you’re requesting a ballot for a family member, fill
     out this section.
4.   Sign your name - If you can’t sign your name, you may ask someone to sign your name in your presence.

Submitting the Application
Send this completed application to the local election office for your city or town. Find contact information for local election
officials at www.VotelnMA.com or by calling 1-800-462-VOTE (8683).
Application Deadlines
This application must reach your local election office by 5 p.m. on the fifth business day before Election Day.
     State Primary Deadline: August 29, 2022
     State Election Deadline: November 1, 2022