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June 5, 2012 Presidential Primary Election Vote-by-Mail Application

Please Note the Following:

1. The deadline to submit this application is May 29, 2012.
2. You must currently be a registered voter in Orange Countyh to use this application. You may verify if you are registered by clicking here.
3. Your Orange County residential address must be provided.
4. This form can not be used to change your name or address.
5. This is a one-time only application. If you would like to become a permanent vote-by-mail voter, please click here.
6. If you are a college student with a temporary residence, please use your permanent address as your residential address, and your temporary address as your mailing address. If you are not registered in Orange County, please contact your local elections official.

If you are currently a permanent vote-by-mail voter, as indicated on your sample ballot, you do not need to fill out this application.

Name (first, middle, last):

Residential Address:





My mailing address is the same as my residential address

Mailing Address (if different than residential address):


Date of Birth (mm/dd/yyyy):

Attention: Voters not affiliated with a qualified political party who wish to receive a vote-by-mail ballot of a qualified political party allowing participation by non-affiliated voters, please check the box below:


I am presently not affiliated with any qualified political party; however, for this election ONLY, I request a vote-by-mail ballot for the following political party:


SOKA University Polling Place
Sample Ballot; Thank you for reading your sample ballot. The sample ballot contains important election information.
Orange County Registrar of Voters | 1300 South Grand Avenue | Building C | Santa Ana CA 92705 | 714.567.7600