Application to Vote by Mail

Full Name

Phone

Physical Address

Mailing Address

City/Town

State/Province

ZIP/Postal Code

Are you a

Non- Resident Elector

Resident Elector

Residential Street Address

City/Town

State/Province

ZIP/Postal Code

I request to be provided a mail ballot package as follows:

Mail to my mailing address

Keep it at Municipal Office for me to pick up

Keep it at Municipal Office for my designate to pick up on my behalf

Mail it to another address

Please enter the name of your designate.

DECLARATION - By signing and submitting this application I declare that I am:

18 years of age or older on general voting day (October 20, 2018); and
a Canadian citizen; and
a resident of the electoral area noted above for at least the past 30 days OR a registered owner of real property in the electoral area noted above for at least the past 30 days; and
a resident of BC for at least the past 6 months; and
not disqualified by any enactment from voting in a Local Government election or otherwise disqualified by law.

Signature

Sign above

Collection of Information: Your personal information is being collected. By providing us with your personal information, you consent to our collection, use and disclosure of that information. This information will only be used to administer the program/activity it was collected for and/or to respond to you regarding the reason you contacted us. If you have any questions about the collection please contact the Municipal Privacy Head.