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Vote By Mail - Ballot Application

Type of Election:

Date of Election:

First Name:

Last Name:

Registered Address:

City:

State:

Zip:

Date Of Birth:

Daytime/Cell Phone:

Evening/Cell Phone:

Email: (REQUIRED)

Email: Confirm

Non-Partisan ballots are available for Referenda only. No Candidates on Non-Partisan ballots.

If the mailing address is planned to be different than the above Registered Address, please fill out the associated mailing address below.

Mailing Address:

City:

State:

Zip:

Phone (Recommended)

I hereby make application for an official ballot to be voted by me at such election, and I agree that I shall return such ballot to the election official issuing the same prior to the closing of the polls on the date of the election or, if returned by mail, postmarked no later than election day.

I understand that this application is made for an official ballot to be voted by me at the election specified in this application and that I must submit a separate application for an official ballot to be voted by me at any subsequent election.

After we receive your application, a packet with the ballot, instructions for voting, certificate envelope, and return mailing envelope will be mailed to you. Our office will not mail ballots more than 40 days or less than five days prior to the election.

I certify that I reside at the address stated above which is located in Madison County; that I am lawfully entitled to vote in the stated election.

Apply to Vote by Mail

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Sorry, Vote by mail is closed at this time.

Vote By Mail - Permanent Application

First Name:

Last Name:

Registered Address:

City:

State:

Zip:

Date Of Birth:

Precinct:

Daytime/Cell Phone:

Evening/Cell Phone:

Email: (REQUIRED)

Email: Confirm

If the mailing address is planned to be different than the found Registered Address above, please fill out the associated mailing address below.

Mailing Address:

City:

State:

Zip:

Phone: (Recommended)

I am currently a registered voter and wish to apply for permanent vote by mail status.

I state that I reside at the address specified above, in the stated precinct and county, that I have lived at such address for 30 days or more preceding this election, that I am lawfully entitled to vote in such precinct at the next regularly scheduled election, and that :

- or -

I hereby make application for an official ballot or ballots to be voted by me at such election, and I agree that I shall return such ballot or ballots to the official issuing the same prior to the closing of the polls on the date of the election or, if returned by mail, postmarked no later than election day, for counting no later than during the period for counting provisional ballots, the last day of which is the 14th day following the election day.

Application For Accessible Vote By Mail Ballot

Type of Election:

Date of Election:

First Name:
Last Name:
Registered Address:
City:
State:
Zip:
Date of Birth:
Daytime/Cell Phone: (Recommended)
Evening/Cell Phone: (Recommended)
Email: (REQUIRED)
Email: Confirm
	Email addresses are not the same!

Party of Ballot Requested: (REQUIRED)

Non-Partisan ballots are available for Referenda only. No Candidates on Non-Partisan ballots.

Check the box and enter Mailing Address

I state that I reside at the address specified above, in the stated municipality and county, that I have resided at such address for at least 30 days; that I am lawfully entitled to vote at said election to be held therein, and that I wish to vote by mail.

I hereby make application for an official ballot or ballots to be voted by me at such election, and I agree that I shall return such ballot or ballots to the official issuing the same prior to the closing of the polls on the date of the election or, if returned by mail, postmarked no later than election day, for counting no later than during the period for counting provisional ballots, the last day of which is the 14th day following election day.

I understand that this application is made for an official vote by mail ballot or ballots to be voted by me at the election specified in this application and that I must submit a separate application for an official vote by mail ballot or ballots to be voted by me at any subsequent election. I swear or affirm that I am a vator with a print disability, and as a result of this disability, I am making a request to receive a vote by mail ballot electronically so that I may privately and independently mark, verify, and print my vote by mail ballot.

After we receive your application, a packet with the ballot, instructions for voting, certificate envelope, and return mailing envelope will be mailed to you. Our office will not mail ballots more than 40 days or less than five days prior to the election.

I certify that I reside at the address stated above which is located in Madison County; that I am lawfully entitled to vote in the stated election.

of the Election Code

I certify that the information set forth in this application is true and correct.

Application For Permanent Accessible Vote By Mail Status

First Name:

Last Name:

Registered Address:

City:

State:

Zip:

Date Of Birth:

Precinct:

Daytime/Cell Phone:

Evening/Cell Phone:

Email (REQUIRED):

Email Confirmation:

If the mailing address is planned to be different than the found Registered Address above, please fill out the associated mailing address below.

Mailing Address:

City:

State:

Zip

Phone {Recommended):

I am currently a registered voter and wish to apply for permanent vote by mail status.

I state that I reside at the address specified above, in the stated municipality and county, that I have resided at such address for at least 30 days; that I am lawfully entitled to vote at the next regularly scheduled election, and that:

- or -

I hereby make application for an official ballot or ballots to be voted by me at such election, and I agree that I shall return such ballot or ballots to the official issuing the same prior to the closing of the polls on the date of the election or, if returned by mail, postmarked no later than election day, for counting no later than during the period for counting provisional ballots, the last day of which is the 14th day following the election day.

the statements set forth in this applications are true and correct.