Complete a Back-up Federal Write-In Absentee Ballot
Fill out the Voter's Declaration/Affirmation and Ballot
The Federal Write-In Absentee Ballot allows voters who have requested their ballot by their state deadline but not received it to vote. Arizona allows you to use this form for both registration and voting in primary, general, and special elections for Federal office. You may not need to fill out this entire form. Check out the instructions below to see what information your state requires.
Open Back-up Federal Write-In Absentee Ballot
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What do I fill in?
Only the following blocks of the Voter's Declaration/Affirmation are required:
Block 1.a: Select the category that describes you.
Block 1.b: Arizona allows you to use this form for registration only if you are eligible to register and vote in the state, and if you provide proof of citizenship. You must provide one of the following for proof of citizenship:
- A photocopy of a birth certificate that verifies citizenship and supporting legal documentation (i.e. marriage certificate) if the name on the birth certificate is not the same as your current legal name
- A photocopy of identification pages of a U.S. passport identifying the applicant
- A photocopy of a driver license or non-operating license from another state within the U.S. (issued after October 1, 1996)
- Certificate of Naturalization Number, enter in Block 6
- Bureau of Indian Affairs Card Number, Tribal Treaty Card Number, or Tribal Enrollment Number, enter in Block 6
- A photocopy of a Tribal Certificate of Indian Blood or Tribal/Bureau of Indian Affairs Affidavit of birth
If you need to include a photocopies mail or fax them along with this form to your County Recorder. Do not send original documents. Photocopies will not be returned to you.
Block 2.a: Name (Last, First, Middle); Block 2.e: Date of Birth
Blocks 2.f and 2.g: Your valid Arizona Driver's License number or Non-operating Identification License number or the last four digits of your Social Security number is required for voter registration. If you do not possess either of these identification numbers, the State shall assign a number that will serve to identify you for voter registration purposes.
Block 3.a through 3.e: Complete street address of your Arizona voting residence. A post office box is not sufficient. If your address includes a rural route, describe its location in Block 6. This address must be different from the one provided in Block 4 and must be within the county where you claim legal voting residence.
Block 4.a: Enter your current mailing address. It must be different from the address you provided in Block 3
Block 5: If using this form to register, enter your political party affiliation or write undeclared or non-partisan. If you are a registered non-partisan or undeclared, you must indicate which party ballot you want to receive in the future.
Block 6: Provide any information that may assist the local election official in accepting this ballot or application.
Block 7: Sign and date. No witness or notary required.
Completing your ballot:
Arizona allows you to use this form for registration and voting in primary, general, and special elections for Federal office. For each office for which you vote, write in either a candidate's name or a political party designation.
Put Voter's Declaration/Affirmation and Voted Ballot into Envelopes
Once the ballot is complete, fold and place it in the security envelope and seal. Place only the voted ballot in the security envelope and do not write on the security envelope. Insert the sealed security envelope and the Voter's Declaration/Affirmation into the mailing envelope and seal.
Optional: You may print this template on your security envelope
Open Security Envelope Template
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Optional: You may be able to use this postage-paid envelope template
Open Postage-Paid Envelope Template
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The postage-paid envelope may be used in the U.S. postal system which includes: all U.S. Military Post Offices (APO/FPO) overseas or through the diplomatic pouch available at U.S. Embassies/Consulates
Submission Options
You must mail your back-up Federal Write-In Absentee Ballot to a specific election official. Find your county or city in the address list below to locate your election official.
Open Election Official Address List
Don't know your county? Go to the county finder. Don't know your zip code? Go to the United States Postal Service website.
If you choose to fax, you MUST also sign and mail this ballot
Fax
If you choose to fax, it is recommended that you fax the form directly to your local election official (fax numbers can be found on Arizona's State Election website). Only certain counties in Arizona allow faxing. You may also use our toll-free fax service:
Inside the U.S.? Fax to:
1-800-368-8683
(703)-693-5527
DSN 223-5527
Outside the U.S.? Show me a list of toll-free fax numbers
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Follow-up
- Check the "Important Dates" section at the top of this page for registration, ballot request, and voted ballot return deadlines.
- Want to submit your Federal Write-In Absentee Ballot by fax? Remember that by faxing your voted ballot you are waiving your right to secrecy.
- If using our Electronic Transmission Service you must use the Fax Coversheet
- If you receive your state absentee ballot after submitting your Federal Write-In Absentee Ballot, fill it out and return it. The state absentee ballot will be counted instead of the back-up ballot if it's received in time.