Skip to main content

Enter Title

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

 Supervisor of Elections, Holmes County
201 N. Oklahoma St., Suite 102, Bonifay, FL  32425 
Phone: (850) 547-1107 * Fax: (850) 547-4168 * Email: therisa@holmeselections.com * Hours: M-F, 8am - 4pm

The Holmes County Supervisor of Elections office is a public entity subject to Chapter 119 of the Florida Statutes concerning public records.  E-mail messages are covered under such laws and are thus subject to disclosure. Under Florida law, e-mail addresses are public records.  If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity.  Instead, contact this office by phone or in writing.