Free Access - The right to find out whether your provisional ballot was counted, and if not, why
Santa Cruz County California Elections

March 2, 2004 Presidential Primary

IMPORTANT: You must enter the requested information in ALL THE FIELDS below.
VOTER INFORMATION WILL BE USED FOR OFFICIAL PURPOSES ONLY

This application can be received by the Santa Cruz County Elections Department in person, by mail, by FAX or by clicking SUBMIT below:

SANTA CRUZ COUNTY ELECTIONS DEPARTMENT
701 OCEAN ST RM 210
SANTA CRUZ CA 95060-4076
831-454-2060 / FAX: 831-454-2445
For all voters whose ballot is not counted because they are not registered to vote in Santa Cruz County, the elections official will send a voter registration card to you following the election and you must complete and return the card in order to be eligible to vote in future elections
* * * PRESS TAB TO ADVANCE TO NEXT FIELD * * *
1. Name:
           First Middle Name or Initial Last
2. DATE OF BIRTH
mm/dd/yyyy
3 E-MAIL: (Optional for confirmation)
4 SANTA CRUZ COUNTY ADDRESS
Please do not use P.O. Box Number or other mailing address

Number and Street

City, State Zip Code
5. TELEPHONE NUMBER: Daytime (Optional)      Evening (Optional