Hernando County Supervisor of ElectionsPlease note: If you receive an error message when you try to submit this request, please contact the Supervisor of Elections Office at 352-754-4125 to make the request.

Request for Absentee Ballot
First Name
 		 Middle Initial
 		 Last Name
 
Date of Birth
 		 Email Address
 
Address you want ballot(s) mailed to:
Address Line 1
 		 Address Line 2
 
City
 		 State
 		 Zip Code
 		 Country
 
Your Residence Address ( address of your voter registration )
Address Line 1
 		 Address Line 2
 
City
 		 State
 		 Zip Code
 

Daytime Phone Number :  
(required)     		Area Code     Phone
   
Please Note:  An absentee ballot  request may be considered canceled when any first-class mail sent by the Supervisor to you, the voter, is returned as undeliverable.
Please select the election or elections for which you want to receive an Absentee Ballot
       
 August 26, 2008 - Primary Election
 November 4, 2008  - General Election
 2010 - Primary Election
 2010 - General Election
  
Requestor Information -Who is making this request?
A request for an absentee ballot can come from the voter, or, if directly instructed by the voter, a member of the voter’s immediate family, or the voter’s legal guardian. The Elections Office will verify the request with the voter.
First Name
 		 Middle Initial
 		 Last Name
 
 Relationship to Voter
  		Driver's License (if available)
 
Address Line 1
 		 Address Line 2
 
City
 		 State
 		  Zip Code
 

Daytime Phone Number :    		Area Code          Phone
     
Comments
 

Please note: If you receive an error message when you try to submit this request, please contact the Supervisor of Elections Office at 352-754-4125 to make the request.