Maryland Mail-in Ballot Request Form

1 12 Maryland Mail-in Ballot Request FormPrint voter informationUse blue or black addressProvide the address where you are registered to vote. No vote by mail, you must be registered to vote in Maryland . Visit to register or update your voter nameSuffix (Jr., Sr., III, IV, if applicable)Middle name or initialThis address must match your voter registration so that we can send the correct Ballot for your precinct or of birth (mm/dd/yyyy)StreetUnit #CityZipStateMD43675 Political party affiliationTo vote in a party s primary , you must choose that political par t can sign up for a Mail-in Ballot for the 2022 elections or for all future elections.

2 July 19, 2022 primary election only November 8, 2022 general election only Both the 2022 primary and general Elections I would like to receive a Mail-in Ballot for all future federal and s tate elections Democratic Green Republican Working Class U naffiliated (independent of any party) Other LibertarianWhere should we send your Ballot ?If you choose option B, we will email you a link to print your Ballot about 3 weeks before the you choose option B or C, we will use the information on your Ballot to mark an official Ballot for you. Then we will scan the official you choose option B or C, you will need to use your own envelope and stamp to return your Ballot by mail.

3 Or you can deliver it to your election office or a drop box (when available).Please see the instructions for Use a pen. No electronic signatures can help you fill out this form except A candidate on your Ballot Your employer or an agentof your employer An officer or agent from your unionVoter, sign and date here (Required)Date (mm/dd/yyyy)XAbout youIn case we have a we have a question, how should we contact you? Text message Email MailAssistant, sign here (Required if the voter received help on this form)Under penalty of perjury, I hereby certify that this voter needed help with this form because he or she has a disability or is unable to read or write.

4 The voter authorized me to complete this form. If the voter could not sign this form, I printed the voter s name and wrote my voter nameXChoose A, B, or C (only choose 1) Send my Ballot (s) by Mail to Same address as aboveA Or a different address:StreetUnit #CityZipStateEmail a link to print my Ballot (s)OrAndBEmailMD Driver s License or ID Card #Issue date (mm/dd/yyyy)Last 4 digits of your Social Security # Fax my Ballot (s)CFaxPhoneEmailFirst nameXXX-XX- to return this formYour deadline depends on how you return this form and on how you want to receive your Ballot . If you mail or hand deliver your Request , your form must be in the office before the deadline.

5 Postmarks don t ElectionReceive your Ballot by mail or faxMail or hand deliver this form by 8pm on Tue, 7/12/2022. Or Email or fax this form or apply online by 11:59pm on Tue, 7/12 your Ballot from an emailMail or hand deliver this form by 5pm on Fri, 7/15/2022. Or Email or fax this form or apply online by 11:59pm on Fri, 7/15 ElectionReceive your Ballot by mail or faxMail or hand deliver this form by 8pm on Tue, 11/1/2022. Or Email or fax this form or apply online by 11:59pm on Tue, 11/1 your Ballot from an emailMail or hand deliver this form by 5pm on Fri, 11/4/2022. Or Email or fax this form or apply online by 11:59pm on F r i , 11/4 / 2 02 2.

6 You can ask for this form in large type. Call your Request statusYou can track your Request and your Ballot at State Board of Elections Box 6486 Annapolis, MD 21401-0486 800-222-8683800-735-2258 (MD Relay Service) n en espa olSi le interesa obtener este formulario en espa ol, llame al a Mail-in ballotAny registered voter can use this form to Request a Mail-in Ballot for Maryland elections. Return your completed signed form to your local board of elections. You can return it by mail, fax, email. You can also drop it off in your local board of elections address at Make sure to return this form by the correct deadline listed primary way to receive your Ballot is by can mail your Ballot to any address you want.

7 You will also receive a return envelope with prepaid postage. You also have other options. We can email you a link so you can print your Ballot , we can fax your Ballot , or you can pick it up in you choose to pick up your Ballot in person, go to your local election office about 45 days before an election . If you want somebody to pick up your Ballot for you, you must provide a Designation of Agent form. Find this form at you submit this form, we will send your Ballot about 30-45 days before the time and Request a Ballot online at will need a MD driver s license or MVA-issued ID card to use the online will I receive my Ballot ?

8 How will I receive my Ballot ?How do I return this form? Request onlineIf you change your mind and want to vote in person, you must use a provisional I change my mind? Maryland Mail-in Ballot Request InstructionsMaryland Where to find your Local Board of ElectionsAllegany County701 Kelly Rd., Ste. 231 Cumberland, MD 21502301-777-5931301-777-2430 County300 S. Center St. Rm. 212 Westminster, MD 21157410 -386 -2080410-876-3925 County133 Industry Hill, MD 21050-1621410 - 638-3565410 - 638-3310 Mary s County23250 Hollywood Box 197 Leonardtown, MD 20650301-475-4200 ext. 1625301-475-4077 Arundel County6740 Baymeadow Box 490 Glen Burnie, MD 21060410-222-6600410-222-6824 County200 Chesapeake Blvd.

9 , Ste. 1900 Elkton, MD 21921-6395410 -996 -5310888-979-8183 County9770 Patuxent Woods Dr., Ste. 200 Columbia, MD 21046410 -313 -5820410-313-5833 County11916 Somerset Ave., Ste 102 Box 96 Princess Anne, MD 21853410-651-0767410 - 651-5130 CityBenton Office E. Fayette St., Rm. 129 Baltimore, MD 21202-3432410-396-5550410-727-1775 (fax)410 -783 -7394 County201 East Charles Box 908La Plata, MD 20646-0908301-934-8972301-870 -3167301-934-6487 County135 Dixon , MD 21620410-778-0038410-778-0265 (fax) @ County215 Bay Box 353 Easton, MD 21601-0353 410-770-8099410-770-8078 County11112 Gilroy Rd., Ste. 104 Hunt Valley, MD 21031410 -887-5700410-832-8493 County501 Court Ln.

10 , Rm. Box 414 Cambridge, MD 21613-0414410-228-2560410 -228-9635 (fax) @ County18753 N. Frederick Ave., Ste. 210 Gaithersburg, MD Box 10159 Rockville, MD 20849-0159240-777-8550800-735-2258 (TDD)240-777-8560 (fax)absentee@ Washington County 17718 Virginia Avenue Hagerstown, MD 21740 240-313-2050240-313-2062 County30 Duke St., Lower Box 798 Prince Frederick, MD 20678410 -535 -2214410-535-5009 County340 Montevue , MD 21702301-600-8683301-600-2344 George s County 1100 Mercantile Ln., St e . 115A Largo, MD 20774301-341-7300301-726-3352 (TDD)301-341-7399 (fax) County345 Snow Hill Box 4091 Salisbury, MD 21803-4091410-548-4830410-548-4849 CountyHealth & Public Services S.