Forklift Experience Shift
Resume:
North Carolina
Absentee Ballot Request Form for *022 2022.08
Request an absentee ballot
You can request an absentee ballot for 1
voter per form, for 1 election at a time.
The information that you provide on this
form will be used to update your current
voter record if signed by the voter. You may
not change your party using this form.
If you are not registered, you must submit
a voter registration form with this request.
How to return this form
Return your completed and signed form to
your county board of elections by 5:00 pm
on the Tuesday before the election.
You can:
• Drop it off in-person
• Mail it
This form can only be returned by:
• The voter or the voter’s near relative or
verifiable legal guardian
• A Multipartisan Assistance Team
• A person who assisted due to the voter’s
disability.
Return this form to:
Questions?
Call
or visit
Request online
Complete, sign, and submit your request
online at votebymail.ncsbe.gov.
Instructions
1: Election Date
Request for 1 election per form.
2: Voter name
Provide your full legal name. If your name
has changed, this form will be used to
update your current voter record.
3: Voter identification
You must provide your date of birth
and one of the following:
• A NC Driver’s License or DMV ID card
number
• The last 4 digits of your social
security number
4: Home address
Provide the street address where you
live as of today. If you are temporarily
living away or displaced from the address
where you live and you plan to return
later, provide your residential (home)
address for voting. However, if you have
abandoned your place of residence and
intend to stay at a new address indefinitely,
you must provide your new address here.
Signing in section 11 will update your voter
registration. If your new address is in a
different county, you will not be able to
update your address using this form and
will need to submit a new voter registration
in your new county.
5: Ballot mailing address
Indicate where you would like your ballot to
be sent. If you do not want your ballot to be
sent to your residential or mailing address,
provide another address here.
6: Accessibility options
Check if you require an absentee ballot for
other possible elections in 2022 due to your
continued or expected illness or disability.
Check the 2nd box in section 6 if you
require an accessible ballot due to
blindness or visual impairment and provide
your email in section 7 so that we may
contact you when the ballot is available.
7: Contact information
This section asks for your contact
information, in case we have questions
about your request. Provide the contact
information for the voter or if the voter
did not fill out the form, the contact
information for the near relative, legal
guardian, or assistant who filled out the
form.
8: Requesting a ballot for a voter
A near relative or legal guardian may request
a ballot for a voter. A near relative is a voter’s:
• Spouse
• Brother or sister
• Parent or stepparent
• Mother/father-in-law
• Child or stepchild
• Son/daughter-in-law
• Grandparent/Grandchild
Any person may request an absentee ballot
for a voter who needs assistance due to
disability.
If you are a near relative or legal guardian
who is requesting a ballot on behalf of a
voter, you may not make changes to the
voter’s registration record
9: Assisting a voter
If you are assisting a voter, complete this
section.
Any voter may receive assistance from
their near relative or verifiable legal
guardian. A voter who needs assistance
due to a disability may receive assistance
from a person of their choice. A voter who
is unable to read or write may receive
assistance from somebody else if no near
relative or legal guardian is available.
For voters living in a facility (clinic,
nursing home, or adult care home)
who do NOT require assistance due to
a disability, certain limitations apply.
The voter must first seek to have a near
relative, legal guardian or Multipartisan
Assistance Team (MAT) to assist with
requesting a balllot. If none of these
options is available within 7 days of making
a request for a MAT, the voter may get
assistance from anyone who is not:
• An owner, manager, director,
or employee of the facility
• An elected official, a candidate, or an
officeholder in a political party
• A campaign manager or treasurer
for a candidate or political party
10: Military or overseas
Complete this section if you claim North
Carolina as your voting residence and are:
• A U.S. citizen currently outside of the
United States
Or a member of one of the following, or a
spouse or dependent of a member of one
of the following:
• The active or reserve components of the
Army, Navy, Air Force, Marine Corps, or
Coast Guard of the United States who is
on active duty
• A member of the Merchant Marines, the
Commissioned Corps of the Public Health
Service, or the Commissioned Corps of
the National Oceanic and Atmospheric
Administration of the United States
• A member of the National Guard or State
militia unit who is on activated status
11: Voter’s signature
This form must be signed by the voter
(unless a near relative or legal guardian
or assistant is requesting a ballot on the
voter’s behalf and fills out section 8). If the
voter cannot physically sign this form, they
can make a mark. A typed signature or
signature fonts are not allowed.
If you indicate that you have changed your
name (section 2) or address (section 4),
signing in this section will update your
voter registration.
Fraudulently or falsely completing this
form is a Class I felony under Chapter
163 of the NC General Statutes.
North Carolina
Absentee Ballot Request Form for 2022
Required sections are in red
Election date
You can request 1 ballot for 1 11/08/2022 General Election only 1 election at a time.
Print voter name
Any name change you give Last name Suffix (Jr, Sr., III, IV, if applicable) on this form will be used to 2 First name Middle name update your registration.
Required Former name (if your name has changed)
Voter identification Date of birth (mm/dd/yyyy) NC Driver’s License/DMV ID number Required 3 AND OR
Last 4 digits of your Social Security number
Home address Street Unit #
Provide your residential City NC Zip County
address (where you live)
and your mailing address (if 4 Have you moved in the last 30 days? Yes No If yes, date moved? (mm/dd/yyyy) different). If you receive mail at a different address or at a Post Office box, provide your full mailing address Required Street Unit #
City State Zip
Where should we Your home address in section 4 Your mailing address in section 4 send your ballot? The address below:
Check 1. 5 Street Unit #
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) Requester’s contact
information 7 Phone Email
Request for ballot by Requester’s name Relationship to voter guardian near relative, or person legal Street Unit # the voter asks to help City State Zip
due to disability 8
Relative/legal guardian/assistant, sign and date here (if applicable) The requester must complete
this section. See instructions
about who can request a
voter’s ballot.
Date (mm/dd/yyyy)
X
Helping a voter fill
out their request?
If yes, complete this section.
See instructions about who
can help a voter.
9
Assistant’s full name
Assistant’s full address
If the voter is in an eligible care facility and
needs assistance in voting and returning the
ballot, enter the facility name below.
Facility Name
Military or
overseas voter?
See instructions 10
Member of the Uniformed Services or Merchant
Marines on active duty or eligible spouse/dependent U.S. citizen outside the U.S. (Overseas address required) Overseas full address
I want my ballot delivered to my:
Fax
Address indicated in section 5
Overseas address provided in this section
Voter’s signature Voter, sign and date here (Required unless ballot requested by a near relative, legal guardian, or assistant) Return form to the County Board of Elections by 5:00 pm on the Tuesday before the election. Do not email or fax. 11
Use a pen. No electronic
signatures allowed.
Required
Date (mm/dd/yyyy)
X
HERTFORD
PO BOX 355
AHOSKIE NC
27910-0355
ALAMANCE
115 S MAPLE ST
GRAHAM NC
27253-2811
ALEXANDER
PO BOX 326
TAYLORSVILLE NC
28681-0326
ALLEGHANY
PO BOX 65
SPARTA NC
28675-0065
ANSON
402 MORVEN RD
WADESBORO NC
28170-2743
ASHE
150 GOVERNMENT CIR
STE 2100
JEFFERSON NC
28640-8959
AVERY
PO BOX 145
NEWLAND NC
28657-0145
BEAUFORT
PO BOX 1016
WASHINGTON NC
27889-1016
BERTIE
PO BOX 312
WINDSOR NC
27983-0312
BLADEN
PO BOX 512
ELIZABETHTOWN NC
28337-0512
BRUNSWICK
PO BOX 2
BOLIVIA NC
28422-0002
BUNCOMBE
PO BOX 7468
ASHEVILLE NC
28802-7468
BURKE
PO BOX 798
MORGANTON NC
28680-0798
CABARRUS
PO BOX 1315
CONCORD NC
28026-1315
CALDWELL
PO BOX 564
LENOIR NC
28645-0564
CAMDEN
PO BOX 206
CAMDEN NC
27921-0206
CARTERET
1702 LIVE OAK ST
STE 200
BEAUFORT NC
28516-1638
CASWELL
PO BOX 698
YANCEYVILLE NC
27379-0698
CATAWBA
145 GOVERNMENT DR
NEWTON NC
28658-0000
CHATHAM
PO BOX 111
PITTSBORO NC
27312-0111
CHEROKEE
40 PEACHTREE ST
MURPHY NC
28906-2940
CHOWAN
PO BOX 133
EDENTON NC
27932-0133
CLAY
75 RIVERSIDE CIR
STE 3
HAYESVILLE NC
28904-7769
CLEVELAND
PO BOX 1299
SHELBY NC
28151-1299
COLUMBUS
PO BOX 37
WHITEVILLE NC
28472-0037
CRAVEN
406 CRAVEN ST
NEW BERN NC
28560-4911
CUMBERLAND
227 FOUNTAINHEAD LN
STE 101
FAYETTEVILLE NC
28301-5493
CURRITUCK
PO BOX 177
CURRITUCK NC
27929-0177
DARE
PO BOX 1000
MANTEO NC
27954-1000
DAVIDSON
945 N MAIN ST
STE A
LEXINGTON NC
27292-2694
DAVIE
161 POPLAR ST
STE 102
MOCKSVILLE NC
27028-2148
DUPLIN
PO BOX 975
KENANSVILLE NC
28349-0975
DURHAM
201 N ROXBORO ST
DURHAM NC
27701-3741
EDGECOMBE
PO BOX 10
TARBORO NC
27886-0010
FORSYTH
201 N CHESTNUT ST
WINSTON SALEM NC
27101-4120
FRANKLIN
PO BOX 180
LOUISBURG NC
27549-0180
GASTON
PO BOX 1396
GASTONIA NC
28053-1396
GATES
PO BOX 621
GATESVILLE NC
27938-0621
GRAHAM
PO BOX 1239
ROBBINSVILLE NC
28771-1239
GRANVILLE
PO BOX 83
OXFORD NC
27565-0083
GREENE
PO BOX 583
SNOW HILL NC
28580-0583
GUILFORD
PO BOX 3427
GREENSBORO NC
27402-3427
HALIFAX
PO BOX 101
HALIFAX NC
27839-0101
HARNETT
PO BOX 356
LILLINGTON NC
27546-0356
HAYWOOD
63 ELMWOOD WAY
STE A
WAYNESVILLE NC
28786-5829
HENDERSON
PO BOX 2090
HENDERSONVILLE NC
28793-2090
HOKE
PO BOX 1565
RAEFORD NC
28376-1565
910-***-**** EXT 1550
HYDE
PO BOX 152
SWAN QUARTER NC
27885-0152
IREDELL
203 STOCKTON ST
STATESVILLE NC
28677-5245
JACKSON
401 GRINDSTAFF COVE RD
SYLVA NC
28779-3250
NC Absentee Ballot Request Form for 2022
County Board Office Mailing Addresses (A–J)
YANCEY
PO BOX 763
BURNSVILLE NC
28714-0763
WILSON
PO BOX 2121
WILSON NC
27894-2121
WAYNE
309 E CHESTNUT ST
GOLDSBORO NC
27530-4903
JOHNSTON
PO BOX 1172
SMITHFIELD NC
27577-1172
JONES
367 NC HIGHWAY 58 S
UNIT B
TRENTON NC
28585-7787
LEE
1503 ELM ST
STE 1
SANFORD NC
27330-4200
LENOIR
PO BOX 3503
KINSTON NC
28502-3503
LINCOLN
PO BOX 977
LINCOLNTON NC
28093-0977
MACON
5 W MAIN ST
FL 1
FRANKLIN NC
28734-3005
828-***-**** EXT 2035
MADISON
PO BOX 142
MARSHALL NC
28753-0142
MARTIN
PO BOX 801
WILLIAMSTON NC
27892-0801
MCDOWELL
PO BOX 1509
MARION NC
28752-1509
MECKLENBURG
PO BOX 31788
CHARLOTTE NC
28231-1788
MITCHELL
11 N MITCHELL AVE
RM 108
BAKERSVILLE NC
28705-6511
MONTGOMERY
PO BOX 607
TROY NC
27371-0607
MOORE
PO BOX 787
CARTHAGE NC
28327-0787
NASH
PO BOX 305
NASHVILLE NC
27856-0305
NEW HANOVER
1241A MILITARY CUTOFF
RD
WILMINGTON NC
28405-3637
NORTHAMPTON
PO BOX 603
JACKSON NC
27845-0603
ONSLOW
246 GEORGETOWN RD
JACKSONVILLE NC
28540-4146
ORANGE
PO BOX 220
HILLSBOROUGH NC
27278-0220
PAMLICO
PO BOX 464
BAYBORO NC
28515-0464
PASQUOTANK
PO BOX 1797
ELIZABETH CITY NC
27906-1797
PENDER
PO BOX 1232
BURGAW NC
28425-1232
PERQUIMANS
PO BOX 336
HERTFORD NC
27944-0336
PERSON
331 S MORGAN ST
ROXBORO NC
27573-5223
PITT
PO BOX 56
GREENVILLE NC
27835-0056
POLK
PO BOX 253
COLUMBUS NC
28722-0253
RANDOLPH
1457 N FAYETTEVILLE ST
ASHEBORO NC
27203-3957
RICHMOND
PO BOX 1843
ROCKINGHAM NC
28380-1843
ROBESON
PO BOX 2159
LUMBERTON NC
28359-2159
ROCKINGHAM
PO BOX 22
WENTWORTH NC
27375-0022
ROWAN
1935 JAKE ALEXANDER
BLVD W STE D10
SALISBURY NC
28147-1176
RUTHERFORD
PO BOX 927
RUTHERFORDTON NC
28139-0927
SAMPSON
335 COUNTY COMPLEX
RD STE 100
CLINTON NC
28328-4851
SCOTLAND
231 E CRONLY ST
STE 305
LAURINBURG NC
28352-3820
STANLY
PO BOX 1309
ALBEMARLE NC
28002-1309
STOKES
PO BOX 34
DANBURY NC
27016-0034
SURRY
PO BOX 372
DOBSON NC
27017-0372
SWAIN
PO BOX 133
BRYSON CITY NC
28713-0133
TRANSYLVANIA
PO BOX 868
BREVARD NC
28712-0868
TYRRELL
PO BOX 449
COLUMBIA NC
27925-0449
UNION
PO BOX 1106
MONROE NC
28111-1106
VANCE
300 S GARNETT ST
STE C
HENDERSON NC
27536-4566
WAKE
PO BOX 695
RALEIGH NC
27602-0695
WARREN
PO BOX 803
WARRENTON NC
27589-0803
WASHINGTON
PO BOX 1007
PLYMOUTH NC
27962-1007
WATAUGA
PO BOX 528
BOONE NC
28607-0528
WILKES
110 NORTH ST
RM 315
WILKESBORO NC
28697-2469
YADKIN
PO BOX 877
YADKINVILLE NC
27055-0877
NC Absentee Ballot Request Form for 2022
County Board Office Mailing Addresses (J–Y)
Contact this candidate