Ballot Replacement Request
If you have lost or not received your ballot, or you made a mistake when voting, please provide the following information to request a replacement ballot be mailed to you or call (808) 270-7749.
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
SSN (last 4), Driver's License, State ID
Residence Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address
*
Street Address or P.O. Box, etc.
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
Reason for reissue:
*
Lost ballot / Did not receive ballot
Mistake when voting
Damage to ballot or return envelope
Other
Authorization
*
I affirm that the information provided above is true and accurate and request that a new ballot be reissued to the address provided.
Sign or initial
*
Submit
Should be Empty: