Form 410 "Uocava Electronic Ballot Application" - Colorado

What Is Form 410?

This is a legal form that was released by the Colorado Secretary of State - a government authority operating within Colorado. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 3, 2018;
  • The latest edition provided by the Colorado Secretary of State;
  • Easy to use and ready to print;
  • Available in Spanish;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 410 by clicking the link below or browse more documents and templates provided by the Colorado Secretary of State.

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Download Form 410 "Uocava Electronic Ballot Application" - Colorado

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UOCAVA Electronic Ballot Application
For office use only
Voter ID Number: ________________________
If you are a Uniformed Service Member, a spouse or dependant of a member, or a U.S. citizen overseas,
you may complete and submit the form below to receive your ballot by fax, email, or online delivery.
Please mail, fax, or email this form as an attachment to your county clerk and recorder.
County contact information:
Your identifying and contact information
Classification:
I am a member of the Uniformed Services
I am their spouse or dependant
I am a U.S. citizen overseas
or Merchant Marine on active duty
Last name*
First name*
Middle name
Previous name if you are currently registered to vote with a different name
Your birthdate* (MM/DD/YYYY)
Telephone number (include area code)
Colorado driver's license number
Last 4 digits of your Social Security No.
Street address in Colorado (No P.O. Boxes)*
Apt. or Unit
City or Town*
ZIP Code*
Colorado County
Mailing address*
Apt. or Unit
City or Town*
State*
ZIP Code*
Preferred method of ballot delivery
Check the box next to your preferred method of ballot delivery. Then complete all required fields marked with an asterisk (*) in that section.
Fax
Provide the number we should dial to deliver your ballot* (See example)
Example: (Geneva, Switzerland)
011
49
30
124456789
International
International
Local Area/
Local
International
International
Local Area/
Local
Prefix
Country Code
Province/
Number
Prefix
Country Code
Province/
Number
City Code
City Code
Primary
Backup email
Email
email*
(optional)
Primary
Backup email
Online delivery
email*
(optional)
Your county clerk will email instructions on online ballot delivery. A link to the ballot delivery system will also be available at
http://www.govotecolorado.com/mil.
Sign or mark below
I affirm that I am a Uniformed Service Member, a spouse/dependant of a member, or a U.S. citizen residing overseas and I understand that I voluntarily waive
my right to a secret ballot if I return my ballot electronically.
Signature or Mark*
Date*
Witness Signature
Date
(If you are unable to sign, you must make a mark and a witness to the
mark must sign here).
Form 410
Sections 1-8.3-108 and 1-8.3-110, C.R.S.
Secretary of State Approved 01-03-2018
UOCAVA Electronic Ballot Application
For office use only
Voter ID Number: ________________________
If you are a Uniformed Service Member, a spouse or dependant of a member, or a U.S. citizen overseas,
you may complete and submit the form below to receive your ballot by fax, email, or online delivery.
Please mail, fax, or email this form as an attachment to your county clerk and recorder.
County contact information:
Your identifying and contact information
Classification:
I am a member of the Uniformed Services
I am their spouse or dependant
I am a U.S. citizen overseas
or Merchant Marine on active duty
Last name*
First name*
Middle name
Previous name if you are currently registered to vote with a different name
Your birthdate* (MM/DD/YYYY)
Telephone number (include area code)
Colorado driver's license number
Last 4 digits of your Social Security No.
Street address in Colorado (No P.O. Boxes)*
Apt. or Unit
City or Town*
ZIP Code*
Colorado County
Mailing address*
Apt. or Unit
City or Town*
State*
ZIP Code*
Preferred method of ballot delivery
Check the box next to your preferred method of ballot delivery. Then complete all required fields marked with an asterisk (*) in that section.
Fax
Provide the number we should dial to deliver your ballot* (See example)
Example: (Geneva, Switzerland)
011
49
30
124456789
International
International
Local Area/
Local
International
International
Local Area/
Local
Prefix
Country Code
Province/
Number
Prefix
Country Code
Province/
Number
City Code
City Code
Primary
Backup email
Email
email*
(optional)
Primary
Backup email
Online delivery
email*
(optional)
Your county clerk will email instructions on online ballot delivery. A link to the ballot delivery system will also be available at
http://www.govotecolorado.com/mil.
Sign or mark below
I affirm that I am a Uniformed Service Member, a spouse/dependant of a member, or a U.S. citizen residing overseas and I understand that I voluntarily waive
my right to a secret ballot if I return my ballot electronically.
Signature or Mark*
Date*
Witness Signature
Date
(If you are unable to sign, you must make a mark and a witness to the
mark must sign here).
Form 410
Sections 1-8.3-108 and 1-8.3-110, C.R.S.
Secretary of State Approved 01-03-2018