ABSENTEE BALLOT LOST OR NOT RECEIVED

Glynn County Board of Elections and Registration
1815 Gloucester St, Brunswick GA 31520

912-554-7060
[email protected]

NAME:*

Date of Birth*

Address:*

Contact Phone or Email Address:*

This is to certify that I have lost or have not received the absentee ballot I requested for the election to be held on: (insert date)*

I request the Glynn County Board of Elections and Registration take this action:*

Cancel my ballot and mail me a replacement. I understand this is only possible during the absentee ballot mailing period.

Cancel my ballot and do NOT mail me a new ballot. I will vote in person during Advanced (Early) Voting or on Election Day at my regular precinct.

Date:*

Signature:
(Type Full Name)

By Submitting my name below I agree that the information above is correct and that I am either the voter or an authorized representative of the voter according to O.C.G.A. § 21-2-381. I acknowledge that fraudulently submitting incorrect information is unlawful in violation of the Oath of Absentee Electors, O.C.G.A. § 21-2-384 . I understand that absentee ballots cannot be mailed after the absentee ballot deadline. If the deadline has passed, the voter must vote in person on Election Day. I understand that I can contact the Board of Elections and Registration to determine if the deadline is passed at 912-554-7060 or [email protected]. If I find or receive my original ballot, it is my responsibility to destroy that ballot so that it cannot be voted or accepted.*

Relationship to Voter: (self, family member, caregiver)*