BALLOT HARVESTING

FOR STAFF USE ONLY

Staff Member Collecting

Name of Staff Member(Requerido)
Please enter a number from 1 to 52.

Voter Information

Name of Voter(Requerido)
MM slash DD slash YYYY
Address of Voter(Requerido)

Ballot Collection

MM slash DD slash YYYY
Time of Ballot Collection(Requerido)
:
Name of Ballot Collector(Requerido)

Authorized Returner

Name of Authorized Returner(Requerido)
MM slash DD slash YYYY
Time of Delivery to ROV(Requerido)
: