Online Early Ballot Request Form

Please fill in all the fields below and press the "request early ballot" button. The information will be given to the Voter Registration Department and they will send the early ballot package following receipt and verification of the request. Any person may assist you with your Early Ballot. If you have any questions please call us at 928-279-4970.

SPECIAL NOTE: Please be advised that the state law has changed. Early ballot request forms must be physically received in this office no later than 5:00 p.m. on the 11th day preceding an election.

* Indicates field is required.

*First Name:
*Last Name:
*Middle Name:
*Residence Address:
*City:
*State:
*Zip Code:
*Phone Number:
*Date of Birth:
*Place of Birth:
Check if you are requesting permanent absent voter status:
Early ballot requested for:
if other:
Choose only one Party Preference for Primary Elections:	You MUST choose one
Mailing Address (if different than residence address):