ABSENTEEBALLOTDESIGNEEFORM

Overview
Florida Statute 101.62(4)(b)4 allows a voter to designate in writing, a person (called a designee) to pick up an absentee ballot from the Volusia County Department of Elections (or from an early voting site when in operation) for the voter.  A ballot may be picked up by a designee no earlier  than 5 days prior to Election Day or on Election Day.  The voter must state the name of the designee in the written document and that he or she is authorized to pick up an absentee ballot for the voter.  If the designee is an immediate family member, the elector must state the relationship in the document. The elector must also sign the document. The designee must present their own signed picture ID when presenting the document to the Department of Elections. The designee must complete an Affidavit for a Designee to Obtain an Absentee Ballot while at the Department of Elections or early voting site.  A person may not pick up more than 2 ballots per election, unless they are for immediate members of their family (see Florida Statute101.62(4)(b)4 referenced above).

Instructions
This form may be used by the voter to designate a designee to pickup their ballot.  The voter may print this form, complete and sign it (very important) and give it to the person  designated to pickup his or her absentee ballot .Instruct the designee that they must have a signed, picture identification in order to pickup the ballot.  The following  form must be signed by the voter and must be hand-delivered to the Department of Elections or early voting site when in operation by the designee.  It may also be faxed to the Department prior to the designee coming to the office.

To be completed by the Voter

 I, designate (insert name of designee) to pick up an

absentee ballot on my behalf for the election to be held on (insert date of election)   .

Voter's Address           Voter's Date of Birth

Designee's  Relationship To The Voter (select one)

£ Is not a member of my immediate family                   

£ Is a member of my immediate family and is my (select one below)

£Spouse               £Parent                £Brother            £Sister

£Child                  £Brother-in-Law   £Sister-in-Law

£Mother-in-Law   £Father-in-Law    £Grandparent  £Grandparent-in-Law

Voter's Signature