Mail-In Paper Application Request

Instructions: Please complete this form to request that a paper mail-in application be sent to you. Learn more about mail ballots at: vote.pa.gov/mailballot

Required fields are marked with an asterisk. (*)

Mailing Information

First Name

Last Name

Suffix

Mailing Address 1

Mailing Address 2 (Suite #, Apt #, etc.)

City

State

Zip Code

Application Type

Mail-In Application (Voters can request a mail-in ballot for any or no reason. The deadline for this application to be received by the county is 5 p.m. on April 16, 2024.)

Language Preference

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