NEED A REPLACEMENT BALLOT?

Affidavit for Replacement Ballot

The owner listed below declares and certifies under penalty of perjury under the laws of the State of California as follows:

* Indicates required field

Property Owner's Name *

First

Last

Email *

Phone Number *

Community Name *

HOA Property Address *

Line 1

Line 2

City

State

Zip Code

Country

Mailing Address for Replacement Ballot *

Line 1

Line 2

City

State

Zip Code

Country

Choose one of the following: *

I did not receive a ballot/envelope(s) for the election. I lost my ballot/envelope(s) for this election My ballot and/or envelope(s) was/were spoiled or otherwise destroyed. Missing Outer Envelope Signature - I was informed by the inspector that I did not sign my outer envelope. I request that this affidavit of authenticity be attached to my previously submitted ballot so that it may be valid and counted during the upcoming tabulation.

Replace the following *

Today's Date *

AFFIDAVIT
I, the undersigned, do hereby declare and certify under penalty of perjury under the laws of the State of California that I am the legal owner of the property listed above and that the statements I have submitted are truthful.

Full Legal Name *

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