Microsoft Word - TransmissionCoversheet_20170808

TransmissionCoverSheet

To:

City/County

BoardofElections

FaxNumber

City

State

From:

LastName

FirstName

MiddleName

TelephoneNumber

FaxNumber

EmailAddress

Numberofpagesbeingtransmitted,includingthissheet:

Notallformscanbesentelectronically.PleasechecktheFVAP.gov

websiteortheVotingAssistanceGuidetoverifywhichformscanbesent

electronicallytoyourElectionOfficial.

Fax:SenddirectlytoyourElectionOfficial.Ifyouareunableandneedfax

assistancesendto:703‐693‐5527/DSN223‐5527or1‐800‐368‐8683or

checkFVAP.govforinternationalfaxnumbers.Ifyouneedtofaxanddonot

haveaccesstoafaxmachineyoucanemailyourformsto[email protected].

Email:Ifyourformscanbee

mailed,DONOTUSEFAX@FVAP.GOV.

Emailthemdirectlytoyourelectionofficial.Emailaddressesforyourelection

officialcanbefoundatFVAP.gov.

IfaVOTEDBALLOTisbeingfaxedoremailed,signbelow:

“IunderstandthatbyfaxingoremailingmyvotedballotIamvoluntarilywaivingmyrighttoasecretballot”

Signature: Date:

AdditionalInformation: