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ABSENTEE BALLOT REQUEST
SOLlCITUD DE BOLETA DE AUSENTE
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VOTI,N,G
AB'SE:NT
BALLOT
M'IAM:I-DJ!
CO.U;N- ·
Date of birth (mandatory)!
Fecha de nacimiento (obligatoria)
inscripci6n (optativOl
Registration # (optional) I Num. de
Nombre del elector
Voter's Name
Current Mlaml-Dade County Residence Address
Direccl6n de su domicllio actual en Mlami-Dade
O Check if this is a change of your residentia' addf8ss,
Marque aqui si es un cambio de \a direcci6n de su domicilio.
NOTICE: The US Post Office will not fofward absentee ballots to a different address. Pursuant to State
Law, if any first class mail addressed to you is returned as undeliverable to our office, the request for
ballots will be cancelled until a new address is provided. It is up to you to keep us informed when you
leave during the election season!
AVlSO: EI Servicio Postal de !os Estados Unidos no permite que se remitan boIetas para electores
ausentes a otra direcci6n. De acuerdo con \a ley estatal, sl alguna correspondencia de primera c1ase
dirigida a Ud. es devuella a nuestra oficina por no poder entregarsele. se cancelaran \as solicitudes de
\as boletas hasta tanto nos suministre su nueva direcci6n. iDe Ud. dependera mantenemos infonnados
si se muda durante \a temporada electoral!
Addf8sS to send ballot if diffef8nt from
f8sidence:
Direcci6n a donde debe enviarse 'a
boleta, si es diferente a 'a de su domicilio:
If you need your bal/otto be sent to an address other than your residence. you must explain why:
$i usted necesila que su boleta sea enviada a otrs direcci6n que no sea la de su domicilio. expfique
porque:
YOTACI.QN POll.
BO.LETA PARA.
EL. 1!!4"!IPftD
." ; ,,-,liV.,
AU.SEMTE
your annual list
I am requesting an absentee ballot for the following election date(s)
Solicito boletas de ausente para las elecciones que se celebraran
en las fachas siguientes:
I am permanently unable to vote at the polls. Please include me on
of absentee voters.
Estoy incapacitado permanentemente para acudir a votar en los centros de
votaci6n. Por favor, incluvanme en su lista anual de electores ausentes.
D
D
Oath: I do solemnly swear (or affirm) that all information on this form is true.
Juramento: Juro solemnemente 0 afirmo que los datos suministrados en este formulario
son ciertos.
- -
Daytime telephone # I Num. de telefono diumo Voter's Signature I Firma del elector
Note: All absentee ballot requests must be signed by the voter and received by the
Elections Department no later than noon on the 4'" calendar dav Drlor to the election.
E-MAIL or FAX requests are accepted only If the ballot is to be mailed overseas.
Avlso: EI elector tiene que firmar toda solicitud de boletas de ausente. EI Departamento de
Elecciones tiene que recibir dichas solicitudes a mas tardar Dara el medlodla del 410 dla
natural anterior alas elecciones. Se aceptara una solicitud enviada por FAX 0
CORREO ELECTRONICO 5610 51 la boleta es para ser envlada al extranJero.
Mlaml-Dade Elections Department I Departamento de Elecciones de Miami-Dade
P.O. Box 012241, Miami, Florida 33101-22411305-375-5858
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