Absentee Ballot Request 
(includes any potential run-off elections) 		Solicitud de Papeleta de Voto en Ausencia
(incluye elecciones con el potencial de desempate) 
Check the election(s) for which you are requesting a ballot.  Marque la(s) elección(es) del cual usted solicita una papeleta. 

Winter Park Primary (if necessary)

February 9, 2010

Primary Election

August 24, 2010

Municipal Election Day

March 9, 2010

General Election

November 2, 2010

Apopka Ocoee
Belle Isle Orlando

All Elections in 2010 & 2012

Edgewood Windermere
Maitland Winter Park
Oakland
* No elections scheduled for Eatonville and Winter Garden

Name  (print)-
Nombre (letra de molde)-

 

Residential Address  (numerical and street)-
Dirección Residencial (numérico y calle)-
  
 

City, State, Zip Code-
Ciudad, Estado,Código Postal-           

 

Daytime Phone  (include area code)-   
Número Telefónico Diurno (incluya código del área)-  

 

Permanent Mailing Address  (if different than residence)-      
Dirección Postal Permanente (si es distinta a la residencial)-
  
 

Signature-
Firma-                                                                                                                                                                                

_______________________________________________________________________________________

Birth Date-
Fecha de Nacimiento-                                                                                                       

 

Voter I.D. number  (if known)-
Núm. de Identidad  (si lo tiene)-                                        

Print in portrait format and send completed form to our office via fax (407-254-6598) or mail to:
Imprima en formato normal al completar la solicitud y envíe por fax al 407-254-6598 o por correo postal:


Bill Cowles- Orange County Supervisor of Elections
PO Box 562001
Orlando FL  32856-2001