Ballot Replacement Form | HOAElectCA.com

AFFIDAVIT FOR REPLACEMENT BALLOT

First Name

Last Name

Phone

Association Name

Property Address

City

State

Zip Code

Mailing Address

City

State

Zip Code

Please Choose From the Following

I did not receive my ballot in the mail.

I lost my ballot and/or return envelope(s) for this election.

My ballot and/or envelope(s) was/were spoiled or otherwise destroyed.

My Ballot Was Returned Unsigned

I am requesting the following action of the Inspector:

Please Please Replace ENTIRE Ballot Packet

Please Replace ONLY the Ballot Itself

My Outer Envelope is Missing My Signature - I was informed by the Inspector of Elections 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.

Today's Date

The owner listed above declares and certifies under penalty of perjury under the laws of the State of California that the above submitted information is true and correct to the best of their knowledge.

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.

AFFIDAVIT FOR REPLACEMENT BALLOT

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