"Absentee Ballot Request Form" - North Carolina

Absentee Ballot Request Form is a legal document that was released by the North Carolina State Board of Elections - a government authority operating within North Carolina.

Form Details:

  • Released on May 1, 2021;
  • The latest edition currently provided by the North Carolina State Board of Elections;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the North Carolina State Board of Elections.

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North Carolina
Absentee Ballot Request Form for 2021
2021.05
Request an
How to return this form
Return this form to:
Return your completed and signed form to
Your county board of elections office.
absentee ballot
your county board of elections by 5:00 pm
County information can be found at
on the Tuesday before the election. You
You can request an absentee ballot for
the end of this document.
can:
1 voter at a time. You can request an
Questions?
• Drop it off in-person
absentee ballot for 1 election at a time.
(919) 814-0700
• Mail it
Call
The information that you provide on this
www.ncsbe.gov
This form can only be returned by:
or visit
form will be used to update your current
voter record.
• The voter
Request online
• The voter’s near relative or
If you are not registered, you must submit
Complete, sign, and submit your request
verifiable legal guardian
a voter registration form with this request.
online at votebymail.ncsbe.gov.
• A Multipartisan Assistance Team
Instructions
7: Contact information
officeholder in a political party
• A campaign manager or treasurer
This section asks for your contact
1: Election
for a candidate or political party
information, in case we have questions
about your request. Provide the contact
You can request 1 absentee ballot for 1
10: Military or overseas
information for the voter or near relative or
election. If you are not affiliated with a
Complete this section if you claim North
legal guardian.
political party and you are requesting a
Carolina as your voting residence and are:
ballot for a primary election, choose 1
8: Requesting for a near relative
• A U.S. citizen currently outside of the
party. View elections at www.ncsbe.gov.
United States
A near relative or legal guardian may request a
2: Voter name
ballot for a voter. A near relative is a voter’s:
Or a member of one of the following, or a
Provide your full legal name. If your name
spouse or dependent of a member of one
• Spouse
has changed, this form will be used to
of the following:
• Brother or sister
update your current voter record.
• The active or reserve components of the
• Parent or stepparent
3: Voter identification
Army, Navy, Air Force, Marine Corps, or
• Mother/father-in-law
Coast Guard of the United States who is
You must provide your date of birth
• Child or stepchild
on active duty
and one of the following:
• Son/daughter-in-law
• A member of the Merchant Marines, the
• A NC Driver’s License or DMV ID card
• Grandparent
Commissioned Corps of the Public Health
number
• Grandchild
Service, or the Commissioned Corps of
• The last 4 digits of your social
If you are a near relative or legal guardian
the National Oceanic and Atmospheric
security number
who is requesting a ballot on behalf of a
Administration of the United States
4: Permanent voter address
voter, you:
• A member of the National Guard or State
Provide the street address where you
militia unit who is on activated status
• must sign in the box in this section
live as of today. If you are temporarily
• may not make changes to the voter’s
11: Voter’s signature
living away or displaced from the address
registration record
This form must be signed by the voter
where you live and you plan to return
9: Assisting a voter
(unless a near relative is requesting a ballot
later, provide your permanent residential
on the voter’s behalf and fills out section
If you are assisting a voter, complete this
address for voting. However, if you have
8). If the voter cannot physically sign this
section.
abandoned your place of residence and
form, they can make a mark. A typed
intend to stay at a new address indefinitely,
Any voter may receive assistance from their
signature or signature fonts are not
you must provide your new address here.
near relative or verifiable legal guardian.
allowed.
Signing in section 11 will update your voter
A voter who is blind, disabled, or unable to
If you indicate that you have changed your
registration. If your new address is in a
read or write may receive assistance from
name (section 2) or address (section 4),
different county, you will not be able to
somebody else if no near relative or legal
signing in this section will update your
update your address using this form and
guardian is available.
voter registration.
will need to submit a new voter registration
in your new county.
If the voter is a patient in a hospital,
clinic, nursing home, or adult care home
5: Ballot mailing address
Fraudulently or falsely
(“facility”) in North Carolina, a member
completing this form is a Class I
Indicate where you would like your ballot to
of a Multipartisan Assistance Team (MAT)
Felony under Chapter 163 of
be sent. If you do not want your ballot to be
can also assist the voter. Contact the
the NC General Statutes.
sent to your residential or mailing address,
county board of elections to request a MAT.
provide another address here.
If a near relative or legal guardian is not
6: Accessibility options
available and a MAT is not available within
7 calendar days of a request, the voter may
Check if you require an absentee ballot for
get assistance from anyone who is not:
other possible elections in 2021 due to your
continued or expected illness or disability.
• An owner, manager, director,
Check if you require an accessible ballot
or employee of the facility
due to blindness or visual impairment.
• An elected official, a candidate, or an
North Carolina
Absentee Ballot Request Form for 2021
2021.05
Request an
How to return this form
Return this form to:
Return your completed and signed form to
Your county board of elections office.
absentee ballot
your county board of elections by 5:00 pm
County information can be found at
on the Tuesday before the election. You
You can request an absentee ballot for
the end of this document.
can:
1 voter at a time. You can request an
Questions?
• Drop it off in-person
absentee ballot for 1 election at a time.
(919) 814-0700
• Mail it
Call
The information that you provide on this
www.ncsbe.gov
This form can only be returned by:
or visit
form will be used to update your current
voter record.
• The voter
Request online
• The voter’s near relative or
If you are not registered, you must submit
Complete, sign, and submit your request
verifiable legal guardian
a voter registration form with this request.
online at votebymail.ncsbe.gov.
• A Multipartisan Assistance Team
Instructions
7: Contact information
officeholder in a political party
• A campaign manager or treasurer
This section asks for your contact
1: Election
for a candidate or political party
information, in case we have questions
about your request. Provide the contact
You can request 1 absentee ballot for 1
10: Military or overseas
information for the voter or near relative or
election. If you are not affiliated with a
Complete this section if you claim North
legal guardian.
political party and you are requesting a
Carolina as your voting residence and are:
ballot for a primary election, choose 1
8: Requesting for a near relative
• A U.S. citizen currently outside of the
party. View elections at www.ncsbe.gov.
United States
A near relative or legal guardian may request a
2: Voter name
ballot for a voter. A near relative is a voter’s:
Or a member of one of the following, or a
Provide your full legal name. If your name
spouse or dependent of a member of one
• Spouse
has changed, this form will be used to
of the following:
• Brother or sister
update your current voter record.
• The active or reserve components of the
• Parent or stepparent
3: Voter identification
Army, Navy, Air Force, Marine Corps, or
• Mother/father-in-law
Coast Guard of the United States who is
You must provide your date of birth
• Child or stepchild
on active duty
and one of the following:
• Son/daughter-in-law
• A member of the Merchant Marines, the
• A NC Driver’s License or DMV ID card
• Grandparent
Commissioned Corps of the Public Health
number
• Grandchild
Service, or the Commissioned Corps of
• The last 4 digits of your social
If you are a near relative or legal guardian
the National Oceanic and Atmospheric
security number
who is requesting a ballot on behalf of a
Administration of the United States
4: Permanent voter address
voter, you:
• A member of the National Guard or State
Provide the street address where you
militia unit who is on activated status
• must sign in the box in this section
live as of today. If you are temporarily
• may not make changes to the voter’s
11: Voter’s signature
living away or displaced from the address
registration record
This form must be signed by the voter
where you live and you plan to return
9: Assisting a voter
(unless a near relative is requesting a ballot
later, provide your permanent residential
on the voter’s behalf and fills out section
If you are assisting a voter, complete this
address for voting. However, if you have
8). If the voter cannot physically sign this
section.
abandoned your place of residence and
form, they can make a mark. A typed
intend to stay at a new address indefinitely,
Any voter may receive assistance from their
signature or signature fonts are not
you must provide your new address here.
near relative or verifiable legal guardian.
allowed.
Signing in section 11 will update your voter
A voter who is blind, disabled, or unable to
If you indicate that you have changed your
registration. If your new address is in a
read or write may receive assistance from
name (section 2) or address (section 4),
different county, you will not be able to
somebody else if no near relative or legal
signing in this section will update your
update your address using this form and
guardian is available.
voter registration.
will need to submit a new voter registration
in your new county.
If the voter is a patient in a hospital,
clinic, nursing home, or adult care home
5: Ballot mailing address
Fraudulently or falsely
(“facility”) in North Carolina, a member
completing this form is a Class I
Indicate where you would like your ballot to
of a Multipartisan Assistance Team (MAT)
Felony under Chapter 163 of
be sent. If you do not want your ballot to be
can also assist the voter. Contact the
the NC General Statutes.
sent to your residential or mailing address,
county board of elections to request a MAT.
provide another address here.
If a near relative or legal guardian is not
6: Accessibility options
available and a MAT is not available within
7 calendar days of a request, the voter may
Check if you require an absentee ballot for
get assistance from anyone who is not:
other possible elections in 2021 due to your
continued or expected illness or disability.
• An owner, manager, director,
Check if you require an accessible ballot
or employee of the facility
due to blindness or visual impairment.
• An elected official, a candidate, or an
North Carolina
Return this form to your county board of elections
by mail or in person. Do not fax or email this form.
Absentee Ballot Request Form for 2021
Your county board of elections contact information
Required sections are in red
can be found on pages 3 and 4 of this document.
Select 1 election
10/5/2021 Election
Democratic
Republican
If you are requesting a ballot for a primary election
You can request 1 ballot for
11/2/2021 Election
Nonpartisan
1
and you are not affiliated with a political party
Libertarian
only 1 election at a time.
(unaffiliated), select your primary ballot preference.
Required
Print voter name
Suffix (Jr, Sr., III, IV, if applicable)
Last name
The name you give on this
First name
Middle name
2
form will be used to update
your registration.
Former name (if your name has changed)
Required
Voter identification
NC Driver’s License/DMV ID number
Date of birth (mm/dd/yyyy)
3
Required
AND
OR
Last 4 digits of your Social Security number
Permanent voter
Street
Unit #
address
City
NC Zip
County
Provide your residential
Have you moved in the last 30 days?
Yes
No
If yes, date moved? (mm/dd/yyyy)
4
address (where you live)
If you receive mail at a different address or at a Post Office box, provide your full mailing address
and your mailing address (if
Street
Unit #
different).
Required
City
State
Zip
Where should we
Your residential address in section 4
Your mailing address in section 4
send your ballot?
A different address:
5
Street
Unit #
Check 1.
Required
City
State
Zip
Accessible voting
I request absentee ballots for all elections this year due to continued or expected illness or disability.
options
6
I require an accessible absentee ballot due to visual impairment. (Provide your email address in section 7)
Contact information
Phone
Email
7
If we have a question.
Requesting a ballot
Requester’s name
Relationship to voter
for a near relative?
Street
Unit #
If yes, the requester must
City
State
Zip
complete and sign this
8
section. See the instructions
Relative/legal guardian, sign and date here (if applicable)
for a list of who can request a
Date (mm/dd/yyyy)
ballot for a voter.
X
Assisting a voter?
If the voter is in an eligible facility and needs
Assistant’s full name
If yes, the assistant must
assistance in voting and returning the ballot,
Assistant’s full address
9
enter the facility name below (if applicable).
complete this section. The
voter must sign or make their
mark in section 11.
Facility Name
Military or
Member of the Uniformed Services or Merchant
I want my ballot delivered to my:
Overseas
Marines on active duty or eligible spouse/dependent
Email
U.S. citizen outside the U.S. (Overseas address required)
(UOCAVA)?
10
Overseas full address
Fax
See instructions
Address indicated in section 5
Overseas address provided in this section
Voter’s signature
Voter, sign and date here (Required unless requesting for a near relative)
Use a pen. No electronic
Date (mm/dd/yyyy)
11
X
signatures allowed.
Required
Return this form to the County Board of Elections by 5:00 pm on the Tuesday before the election. Do not email.
North Carolina
Absentee Ballot Request Form for 2021
County Boards of Elections Contact Information for Municipal Elections (A–H)
Contact information is not included for the following counties due to no scheduled election this year or no absentee voting:
1.
Alexander
11. Gates
2.
Alleghany
12. Hyde
Find out if absentee voting is available in
3.
Anson
13. Madison
4.
Ashe
14. Mitchell
your municipality.
5.
Camden
15. Pasquotank
6.
Cherokee
16. Stanly
Not every municipality offers voting by mail-in ballot.
7.
Chowan
17. Surry
Confirm election dates and absentee voting options
8.
Clay
18. Swain
online at ncsbe.gov/2021-municipal-voter-tool.
9.
Craven
19. Vance
10. Currituck
20. Yancey
ALAMANCE
AVERY
BEAUFORT
BERTIE
BLADEN
115 S MAPLE ST
PO BOX 145
PO BOX 1016
PO BOX 312
PO BOX 512
GRAHAM NC
NEWLAND NC
WASHINGTON NC
WINDSOR NC
ELIZABETHTOWN NC
27253-2811
28657-0145
27889-1016
27983-0312
28337-0512
(336) 570-6755
(828) 733-8282
(252) 946-2321
(252) 794-5306
(910) 862-6951
BRUNSWICK
BUNCOMBE
BURKE
CABARRUS
CALDWELL
PO BOX 2
PO BOX 7468
PO BOX 798
PO BOX 1315
PO BOX 564
BOLIVIA NC
ASHEVILLE NC
MORGANTON NC
CONCORD NC
LENOIR NC
28422-0002
28802-7468
28680-0798
28026-1315
28645-0564
(910) 253-2620
(828) 250-4200
(828) 764-9010
(704) 920-2860
(828) 757-1326
CARTERET
CASWELL
CATAWBA
CHATHAM
CLEVELAND
1702 LIVE OAK ST STE 200
PO BOX 698
PO BOX 132
PO BOX 111
PO BOX 1299
BEAUFORT NC
YANCEYVILLE NC
NEWTON NC
PITTSBORO NC
SHELBY NC
28516-1638
27379-0698
28658-0132
27312-0111
28151-1299
(252) 728-8460
(336) 694-4010
(828) 464-2424
(919) 545-8500
(704) 484-4858
COLUMBUS
CUMBERLAND
DARE
DAVIDSON
DAVIE
PO BOX 37
227 FOUNTAINHEAD LN
PO BOX 1000
PO BOX 1084
161 POPLAR ST STE 102
WHITEVILLE NC
STE 101
MANTEO NC
LEXINGTON NC
MOCKSVILLE NC
28472-0037
FAYETTEVILLE NC
27954-1000
27293-1084
27028-2148
(910) 640-6609
28301-5493
(252) 475-5631
(336) 242-2190
(336) 753-6072
(910) 678-7733
DUPLIN
DURHAM
EDGECOMBE
FORSYTH
FRANKLIN
PO BOX 975
PO BOX 868
PO BOX 10
201 N CHESTNUT ST
PO BOX 180
KENANSVILLE NC
DURHAM NC
TARBORO NC
WINSTON SALEM NC
LOUISBURG NC
28349-0975
27702-0868
27886-0010
27101-4120
27549-0180
(910) 296-2170
(919) 560-0700
(252) 641-7852
(336) 703-2800
(919) 496-3898
GASTON
GRAHAM
GRANVILLE
GREENE
GUILFORD
PO BOX 1396
PO BOX 1239
PO BOX 83
PO BOX 583
PO BOX 3427
GASTONIA NC
ROBBINSVILLE NC
OXFORD NC
SNOW HILL NC
GREENSBORO NC
28053-1396
28771-1239
27565-0083
28580-0583
27402-3427
(704) 852-6005
(828) 479-7969
(919) 693-2515
(252) 747-5921
(336) 641-3836
HALIFAX
HARNETT
HAYWOOD
HENDERSON
HERTFORD
PO BOX 101
PO BOX 356
63 ELMWOOD WAY STE A
PO BOX 2090
PO BOX 355
HALIFAX NC
LILLINGTON NC
WAYNESVILLE NC
HENDERSONVILLE NC
AHOSKIE NC
27839-0101
27546-0356
28786-5829
28793-2090
27910-0355
(252) 583-4391
(910) 893-7553
(828) 452-6633
(828) 697-4970
(252) 358-7812
North Carolina
Absentee Ballot Request Form for 2021
County Boards of Elections Contact Information for Municipal Elections (H–Y)
HOKE
IREDELL
JACKSON
JOHNSTON
JONES
PO BOX 1565
203 STOCKTON ST
876 SKYLAND DR STE 1
PO BOX 1172
367 NC HIGHWAY 58 S
RAEFORD NC
STATESVILLE NC
SYLVA NC
SMITHFIELD NC
UNIT B
28376-1565
28677-5245
28779-5320
27577-1172
TRENTON NC
910-875-8751 EXT 1550
(704) 878-3140
(828) 586-7538
(919) 989-5095
28585-7787
(252) 448-3921
LEE
LENOIR
LINCOLN
MACON
MARTIN
PO BOX 1443
PO BOX 3503
PO BOX 977
5 W MAIN ST FL 1
PO BOX 801
SANFORD NC
KINSTON NC
LINCOLNTON NC
FRANKLIN NC
WILLIAMSTON NC
27331-1443
28502-3503
28093-0977
28734-3005
27892-0801
(919) 718-4646
(252) 523-0636
(704) 736-8480
(828) 349-2034 EXT 2035
(252) 789-4317
MCDOWELL
MECKLENBURG
MONTGOMERY
MOORE
NASH
PO BOX 1509
PO BOX 31788
PO BOX 607
PO BOX 787
PO BOX 305
MARION NC
CHARLOTTE NC
TROY NC
CARTHAGE NC
NASHVILLE NC
28752-1509
28231-1788
27371-0607
28327-0787
27856-0305
(828) 659-0834
(704) 336-2133
(910) 572-2024
(910) 947-3868
(252) 459-1350
NEW HANOVER
NORTHAMPTON
ONSLOW
ORANGE
PAMLICO
1241A MILITARY CUTOFF
PO BOX 603
246 GEORGETOWN RD
PO BOX 220
PO BOX 464
RD
JACKSON NC
JACKSONVILLE NC
HILLSBOROUGH NC
BAYBORO NC
WILMINGTON NC
27845-0603
28540-4146
27278-0220
28515-0464
28405-3637
(252) 534-5681
(910) 455-4484
(919) 245-2350
(252) 745-4821
(910) 798-7330
PENDER
PERQUIMANS
PERSON
PITT
POLK
PO BOX 1232
PO BOX 336
331 S MORGAN ST
PO BOX 56
PO BOX 253
BURGAW NC
HERTFORD NC
ROXBORO NC
GREENVILLE NC
COLUMBUS NC
28425-1232
27944-0336
27573-5223
27835-0056
28722-0253
(910) 259-1220
(252) 426-5598
(336) 597-1727
(252) 902-3300
(828) 894-8181
RANDOLPH
RICHMOND
ROBESON
ROCKINGHAM
ROWAN
1457 N FAYETTEVILLE ST
PO BOX 1843
PO BOX 2159
PO BOX 22
1935 JAKE ALEXANDER
ASHEBORO NC
ROCKINGHAM NC
LUMBERTON NC
WENTWORTH NC
BLVD W STE D10
27203-3957
28380-1843
28359-2159
27375-0022
SALISBURY NC
(336) 318-6900
(910) 997-8253
(910) 671-3080
(336) 342-8107
28147-1176
(704) 216-8140
RUTHERFORD
SAMPSON
SCOTLAND
STOKES
TRANSYLVANIA
PO BOX 927
120 COUNTY COMPLEX
231 E CRONLY ST STE 305
PO BOX 34
PO BOX 868
RUTHERFORDTON NC
RD STE 110
LAURINBURG NC
DANBURY NC
BREVARD NC
28139-0927
CLINTON NC
28352-3820
27016-0034
28712-0868
(828) 287-6030
28328-4851
(910) 277-2595
(336) 593-2409
(828) 884-3114
(910) 592-5796
TYRRELL
UNION
WAKE
WARREN
WASHINGTON
PO BOX 449
PO BOX 1106
PO BOX 695
PO BOX 803
PO BOX 1007
COLUMBIA NC
MONROE NC
RALEIGH NC
WARRENTON NC
PLYMOUTH NC
27925-0449
28111-1106
27602-0695
27589-0803
27962-1007
(252) 796-0775
(704) 283-3809
(919) 404-4040
(252) 257-2114
(252) 793-6017
WATAUGA
WAYNE
WILKES
WILSON
YADKIN
PO BOX 528
309 E CHESTNUT ST
110 NORTH ST RM 315
PO BOX 2121
PO BOX 877
BOONE NC
GOLDSBORO NC
WILKESBORO NC
WILSON NC
YADKINVILLE NC
28607-0528
27530-4903
28697-2469
27894-2121
27055-0877
(828) 265-8061
(919) 731-1411
(336) 651-7339
(252) 399-2836
(336) 849-7907
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