ELECTION MATERIAL REQUEST SHEET
HOLMES COUNTY, FLORIDA
DATE: __________________________
REQUEST FOR: ___________________________________________________
(Name of organization, committee, candidate or individual)
PERSON DESIGNATED TO RECEIVE REQUEST: _________________________________________
(If Applicable)
PLEASE MAKE YOUR SELECTION FROM THE OPTIONS BELOW: (NOTE: All Vote-By-Mail voter information is exempt from F.S. 119.07(1) and available only to those specified in F.S. 101.62(3).
_____Printed Voter List (.15 per page)
_____Printed List of Vote-By-Mail Ballot Requests (.15 per page)
_____Voter List CD (No Charge if CD provided)
_____Vote-By-Mail Ballot Requests CD (No Charge if CD provided)
_____Voter List VIA EMAIL (No Charge) _____________________________________________________
Email Address
_____Vote-By-Mail Ballot Requests VIA EMAIL (No Charge) ________________________________________
Email Address
PLEASE MAKE YOUR SELECTION FROM THE OPTIONS BELOW:
PARTY SELECTION: PRECINCT SELECTION:
_____All Voters _____All Precincts
_____Democrats _____Precinct Number(s) ______________
_____Republicans _____District Number(s) ______________
SORT OPTIONS: ADDRESS:
_____Name _____Mailing Address
_____Name by Precinct _____Residence Address
_____Address _____Residence and Mailing Address
_____Household _____Vote-By-Mail Ballot Mailing Address
_____________________________________ _____________________________________
Signature of Candidate OR Person Authorized By Signature of Person Receiving Material
Qualified Organization; Political Party; Committee
FOR OFFICE USE:
Original Request Received ____________________ Update Request Received ____________________
Job date from ________________ to ____________ Date Requested for Receipt ___________________
Fee Amount $______________ Check #________
Note: Please Make Check Payable to Supervisor of Elections