Request an Absentee Ballot

BY FLORIDA STATUTE, IF YOU WOULD LIKE TO VOTE BY MAIL, YOUR REQUEST MUST BE RECEIVED NO LATER THAN 5 PM ON WEDNESDAY BEFORE THE ELECTION A VOTER MAY REQUEST AN ABSENTEE BALLOT BY:

Email:

Fill out the form below. * - Indicates a required field.

Phone:

(863) 534-5888.

Mail:

Send your request to:.

Polk County Supervisor of Elections Office
PO Box 1460
Bartow, FL 33831

When writing to request an absentee ballot, please include the following: Name, residence address, date of birth, signature, and the address where the ballot should be mailed.

Absentee Ballot Request Form:

* Name of Voter:

First	Middle	Last	Suffix

Active Military

Voter's Current Polk County Residence Address:

* Address:

Street Number	Street Type	Post

City	State	Zip

* Date of Birth:

(mm/dd/yyyy)

Telephone Number:

Why do we need your email address?
If we cannot find your voter registration information in our files, we will need to contact you. Please provide a valid email address.

* E-Mail Address:

* Confirm E-Mail:

IMPORTANT NOTE
Under Florida Law, e-mail addresses are public records. If you do not want your email address released to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing. Effective July 1, 2006.

* Requesting Absentee Ballot for:

All elections through 2010
All elections through 2012
Specific elections:
PRIMARY ELECTION (SEE GENERAL 2010) - 8/24/2010
GENERAL ELECTION - 11/2/2010
GENERAL ELECTION - 11/6/2012

Ballot to be mailed to:

* Address:

* City:

, St: Zip:

Country:

Request by immediate family or legal guardian for the voter:

If you are requesting an absentee ballot for an immediate family member or are a legal guardian, you must complete the section below.
I have been instructed by the voter to make this request

Requester Information:

* Requester's Name:

* Relationship To The Voter:

* Requester's Complete Address:

* Requester's Driver's License Number:

Instructions on how to fill out the ballot, the secrecy envelope, mailing envelope, and voter's certificate, are included with your absentee ballot.

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