Virginia Absentee Ballot Application Form

SBE-701/703.1 Rev. 7/2022

Print your

Personal

Information

Last Name:

First Name:

Middle Name:

Suffix:

Social Security # (last 4 digits required):

Birth Year (optional):

Registration

Address

Address:

Apt/Suite #:

City:

Zip Code:

If rural address or homeless, describe residence.

Absentee

Ballot for

One Election

I want to vote an absentee ballot in the:

☐

General or Special Election

☐

Democratic Primary

☐

Republican Primary

Date of Election:

YYYY

in the city/county of:

Permanent

Absentee

Option

Do you want to vote by mail for all future elections?

☐ Yes ☐ No

If yes, which party primary ballots would you like to receive? You may select one party designation under Virginia law.

☐

Democratic Party

☐

Republican Party

☐

I do not wish to receive ballots for Primary Elections

Ballot

Mailing

Address

different from

section 2

If you chose the Permanent Absentee Option in Section 4 above, do not fill out this section.

Address:

Apt/Suite #:

City:

State:

Zip Code:

Country:

Contact

info

(Optional)

Telephone:

Email/Fax:

Section 7 only applies to some voters. Leave blank and skip to Section 8 if none of these apply to you.

Change of

Name/

Address

Former Full Name:

Former Address:

Date Moved:

City:

State:

Zip code:

Military or

Overseas

Voters

If you are a military/overseas voter OR a spouse/dependent, we need to know more:

1. Turn the form over to find your category under the Military and Overseas Section.

2. Print category letter code here: ______________. If applicable, last date of residency: _________________.

3. Deliver my ballot to:

☐ Residence address from Section 2

☐ Email address from Section 6

☐

Ballot mailing address from Section 5

☐

Fax number from Section 6

Assistance

with Ballot

☐

I need assistance completing my ballot due to a

disability, blindness, or an inability to read or write.

If checked, an assistance form will be sent with the

ballot.

☐

I am a print-disabled voter and would like to receive my ballot

electronically at the email address provided above in Section 6. You will

Receive your ballot electronically and your general registrar will send

you the proper envelopes to return your ballot.

Assistance

with this

Form

Assistant, fill in your information below and sign if applicant is unable to sign due to disability:

Assistant’s Full Name:

Phone:

Assistant’s Address:

Apt/Suite:

City:

State:

Zip code:

I swear/affirm, subject to felony penalties for making false statements pursuant to VA Code § 24.2-1016, that (1) the

information provided in this form is true, and (2) I have written “Applicant unable to sign” on the applicant’s

signature line in Section 8.

Assistant, sign here:

Date:

Voter’s

Statement +

Signature

I swear/affirm, subject to felony penalties for making false statements pursuant to VA Code § 24.2-1016, that (1) the information

provided in this form is true, (2) I am not requesting a ballot or voting in any other jurisdictions in the US, and (3) I am registered to vote

in the city/county where I am applying to vote.

Voter, sign here (or mark if unable): X

Date:

Office use only

Precinct:

District/Senate/House:

Application #

App accepted:

□

Yes



Date received:

Received by:

Reason not accepted

Method received:

□Email □ Fax □ Mail □ In person □ Other

Ballot sent by:

□

Fax

□

Mail

Virginia Absentee Ballot Application Form

SBE-701/703.1 Rev. 7/2022

Privacy Act Notice: This form requires personal information. The last

four (4) digits of your Social Security Number are required. Your

application will be denied if you fail to provide the last four digits of your

Social Security Number or if you fail to provide any other information

required to determine your qualification to vote by mail. Federal law (the

Privacy Act of 1974; the Help America Vote Act of 2002) and state law

(Virginia Constitution, article II, § 2; § 24.2- 701, Code of Virginia; the

Government Data Collection and Dissemination Practices Act) authorize

collecting this information and restrict its use to official purposes only.

Warning: Intentionally voting more than once in an election or making a

materially false statement on this form constitutes the crime of election

fraud. Intentionally voting more than once in an election is punishable

under Virginia law as a Class 6 felony and is punishable by a term of

imprisonment of up to five years, or confinement in jail for not more

than 12 months, and/or a fine of not more than $2,500. Making a

materially false statement on this form is punishable under Virginia law

as a Class 5 felony and is punishable by a term of imprisonment of up to

ten years, confinement in jail for not more than 12 months, and/or a fine

of not more than $2,500.

Instructions

How to Apply to Vote an Absentee Ballot

To vote an absentee ballot, complete this form and submit it to your

local voter registration office. You can find the contact information for

your local voter registration office through the Department of Elections’

website,

https://vote.elections.virginia.gov/VoterInformation/PublicContactLookup.

If you prefer to vote in person, this form is not needed.

General Information

You can apply to vote absentee for just one election (Section 3) or for all

elections (Section 4).

If you choose to vote absentee in one election, a separate form is

required for each election. To apply to vote absentee in all future

elections, please see the instructions for “Permanent Absentee Option

(Section 4).”

Your local office must receive your application by mail, email, or fax by

5:00 pm on the eleventh (11th) day before the election.

Ballots are available 45 days before an election. (If you register to vote in

person, you must wait five days before you can have your ballot mailed

to you.)

Your Personal Information (Section 1)

Provide your personal information. Your name and the last four digits of

your Social Security number are required.

Registration Address (Section 2)

Provide the address listed in your voter registration record. If you have a

rural address or are homeless, please describe where you live.

Absentee Ballot for One Election (Section 3)

Fill out Section 3 if you only want to receive an absentee ballot for one

election. In the spaces provided, indicate for which election you would

like to receive an absentee ballot (General Election, Special Election,

Democratic Primary, or Republican Primary). Make sure to add the date

of the election and include the county or city in which you live. By filling

out Section 3, you will receive an absentee ballot only for the election

you have indicated.

Permanent Absentee Option (Section 4)

If you checked the “Yes” box in Section 4, you are indicating that you

wish to receive your ballot in the mail for every election in the future.

Ballots for all future elections will be sent to the address in your voter

registration record. If you need your ballot sent to a different address or

want to change the political party you’ve chosen for Primary Elections,

please use form SBE-703.1C.

If you move to a new county or city, complete a new form and submit it

to your new general registrar to continue receiving ballots.

If you want to receive a primary ballot, you must indicate a political party

preference. If you do not want a ballot for primary elections, please mark

the last box or leave the answer to this question blank.

Ballot Mailing Address (Section 5)

Only fill out this section if

● you want to vote absentee in one election and have filled out

Section 3; and

● you want your ballot mailed to a different address than the

one in your voter registration record.

Your ballot can only be mailed to one of the following:

1. Your residence address

2. Your location while outside your city/county of residence

3. Your place of temporary confinement for illness, disability,

misdemeanor conviction, or awaiting trial

Ballots cannot be forwarded or sent “in care of”/“to the attention of”

another person.

Military and Overseas Voters (Section 7b)

The Uniformed and Overseas Citizen Absentee Voting Act (UOCAVA)

entitles certain individuals to receive their vote by mail ballots by email

or fax. If you meet one or more of the following UOCAVA voter

categories, please enter the code(s) for that category in section 7b of this

form.

A. I am an active duty merchant marine or in the armed forces.

B. I am a spouse or dependent living with an active duty merchant

marine or armed forces member.

C. I am temporarily residing outside of the U.S. for a non-employment

related reason.

(Voter Registration Office: review VA Code § 24.2-453)

If you have given up your address permanently or have no intent to

return, enter your last date of residency in section 7b, line 2.

D. I am temporarily residing outside of the U.S. for employment or a

spouse or dependent living with a person temporarily residing

outside of the U.S. for employment.

While UOCAVA voters may use this form, they are encouraged to use the

Federal Post Card Application (FPCA) (which also serves as a voter

registration application/update). If you do submit this Virginia Vote by

Mail form (ELECT-701), it will be interpreted as a request by you to

discontinue any FPCA you have previously submitted. For more

information on or to obtain the FPCA, visit https://www.fvap.gov/.

If your ballot is being emailed to you, ensure you monitor your

junk/spam email folders. If your ballot is being faxed to you, ensure you

monitor your fax machine. The Department of Elections and your local

voter registration office are not responsible for emailed or faxed ballots

that are routed to a junk/spam folder or are not received by you.

Voter’s Statement and Signature (Section 8)

In order for the application to be valid, you must sign the application or,

if you are disabled and unable to sign, the person assisting you with

filling out your application should write “Voter unable to sign” on the line

and fill out Section 7d.