Voter Alternate Address Request Form

Voter Alternate Address Request Form
Who is eligible to file an Alternate Address Request Form: Any person who is registered to vote in the state of Utah may file this form (See Utah Code 20A-3a-202)

Voters living outside of the United States or serving in the military may file this form in order to request that a ballot be sent to them electronically.

When to submit an Alternate Address Request: The county clerk must receive the request no later than 11 days before the election.

How to cancel an Alternate Address Request: Contact our office at 435-755-1460 or elections@cachecounty.gov.
Name*

First NameMiddle NameLast Name
Your Utah Residential Address *
No PO Boxes
Unit or Apt Number
CityCountyStateZip Code
Birthdate*

MonthDayYear
Date
Please send my ballot to the address below between:
Start date*

MonthDayYear
End date*

MonthDayYear
Mailing address*
The address where you would like to receive your ballot.
Unit or Apt Number
CityStateZip
Select any that apply to you

I am a voter residing outside the United StatesI am an active military voter or a dependent of one.
Since you are a military or overseas voter, you may designate a fax number or email address where your ballot will be sent
Read and Sign below

Voter Declaration: I do swear (or affirm), subject to penalty of law for false statements, that the information contained in this form is true and that I am a citizen of the United States and a resident of the State of Utah, residing at the above address.
Signature*

Clear
Todays Date*

MonthDayYear
Date
Should be Empty:

Voter Alternate Address Request Form

Please send my ballot to the address below between: