State of Utah - Voter Alternate Address Request Form

Who is eligible to file an Alternate Address Request Form:

Any person who is registered to vote in the state of Utah may file this form (See Utah Code 20A-3a-202).

How to apply for your ballot to be sent to an address other than your primary residence:

Fill out this request form, and then mail, email, or deliver the form to your county clerk's office or the Office of the Lieutenant Governor. You may also complete this form online at VOTER.UTAH.GOV.

Voters living outside of the United States or serving in the military may file this form in order to request that a ballot be sent to them electronically.

When to submit an Alternate Address Request:

The county clerk must receive the request no later than 11 days before the election. See the reverse side of this form for your county clerk's mailing address and contact information.

How to cancel an Alternate Address Request:

Contact your county clerk if you no longer wish to receive your ballot at your Alternate Address.

Return this form to:

Your county clerk's office
(See the reverse side of this form for mailing address and contact information)

Office of the Lieutenant Governor
350 N. State St., Ste. 220
PO Box 142325
Salt Lake City, UT 84114

File online at:
voter.utah.gov
or email to
elections@utah.gov

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Do not write above the dotted line

Write your birth date below:

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Last Name

First Name

Middle Name

Residential Address (no P.O. Boxes)

Unit or Apt. Number

City or Town

State

Zip Code

County in Utah

Please send my by-mail ballot to the address below between:

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and

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Mailing Address or P.O. Box

Unit or Apt. Number

City or Town

State

Zip Code

I am a voter residing out of the U.S. I am an active military voter or a dependent of one

If you checked either of the boxes above, you may designate a fax number or email address where your ballot will be sent:

Read and Sign below

Voter Declaration: I do swear (or affirm), subject to penalty of law for false statements, that the information contained in this form is true and that I am a citizen of the United States and a resident of the State of Utah, residing at the above address.

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