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Voter Registration and Absentee Ballot Request Federal Post Card Application (FPCA) Print clearly in blue or black ink, please see back for instructions. This form is for absent Uniformed Service members, their families, and citizens residing outside the United States. It is used to register to vote, request an absentee ballot, and update your contact information. See your state’s instructions at FVAP.gov. 1. Who are you? Pick one. I am on active duty in the Uniformed Services or Merchant Marine -OR I am an eligible spouse or dependent. I request an absentee I am a U.S. citizen living outside the country, and I intend to return. ballot for all elections in which I am eligible I am a U.S. citizen living outside the country, and my intent to return is uncertain. to vote AND: I am a U.S. citizen living outside the country, and I have never lived in the United States. Female Sex Last name Suffix (Jr., II) Male First name Previous names (if applicable) Middle name Birth date (MM/DD/YYYY) / / Social Security Number Driver’s license or State ID # Your voting materials will not be sent to this address. See instructions on other side of form. 2. What is your address in the U.S. state or territory where you are registering to vote and requesting an absentee ballot? Street address Apt # City, town, village State County ZIP 3. Where are you now? You MUST give your CURRENT address to receive your voting materials. Your mailing address. (Different from above) Your mail forwarding address. (If different from mailing address) 4. What is your contact information? This is so election officials can reach you about your request. Provide the country code and area code with your phone and fax number. Do not use a Defense Switched Network (DSN) number. Email: Phone: Alternate email: Fax: 5. What are your preferences for upcoming elections? Mail Email or online Fax A. How do you want to receive voting materials from your election office? (Select One) B. What is your political party for primary elections? 6. What additional information must you provide? Puerto Rico and Vermont require more information, see back for instructions. Additional state instructions may be found at FVAP.gov. You may also use this space to clarify your voter information. 7. You must read and sign this statement. I swear or affirm, under penalty of perjury, that: The information on this form is true, accurate, and complete to the best of my knowledge. I understand that a material misstatement of fact in completion of this document may constitute grounds for conviction of perjury. I am a U.S. citizen, at least 18 years of age (or will be by the day of the election), eligible to vote in the requested jurisdiction, and I am not disqualified to vote due to having been convicted of a felony or other disqualifying offense, nor have I been adjudicated mentally incompetent; or if so, my voting rights have been reinstated; and I am not registering, requesting a ballot, or voting in any other jurisdiction in the United States, except the jurisdiction cited in this voting form. X Sign here Today’s date (MM/DD/YYYY) / / This information is for official use only. Any unauthorized release may be punishable by law. Previous editions are obsolete. Standard Form 76 (Rev.04-2019), OMB No. 0704-0503 ---PAGE BREAK--- You can vote wherever you are. 1. Fill out your form completely and accurately. • Your U.S. address is used to determine where you are eligible to vote absentee. For military voters, it is usually your last address in your state of legal residence. For overseas citizens, it is usually the last place you lived before moving overseas. You do not need to have any current ties with this address. DO NOT write a PO Box # in section 2. • Most states allow you to provide a Driver’s License number or the last 4 digits of your SSN. Some states require a full SSN. See your state’s guidelines at FVAP.gov. • If you cannot receive mail at your mailing address, please specify a mail forwarding address. • Most states require you to specify a political party to vote in primary elections. This information may be used to register you with a party. • Section 6 Requirements: If your voting residence is Vermont, you must acknowledge the following by writing in section 6: “I swear or affirm that I have taken the Vermont Voter’s Oath.” If your voting residence is in Puerto Rico, you must list your mother’s and father’s first name. • We recommend that you complete and submit this form every year while you are an absentee voter. 2. Remember to sign this form! 3. Remove the adhesive liner from the top and sides. Fold and seal If you printed out the form yourself you can fold the form and seal it in an envelope. • You can find the address for your election office at FVAP.gov. • All states accept this form by mail, but they vary on email and fax. See your state’s rules in the Voting Assistance Guide at FVAP.gov. Agency Disclosure Statement The public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden to: Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management Division, 4800 Mark Center Dr., East Tower, Suite 03F09, Alexandria, VA 22350-3100. [OMB Control #0704-0503]. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. DO NOT RETURN YOUR FORM TO THE ADDRESS ABOVE. Privacy Advisory When completed, this form contains personally identifiable information and is protected by the Privacy Act of 1974, as amended. Questions? Email [EMAIL REDACTED] From U.S. Postage Paid (Your name and mailing address) 39 USC 3406 PAR AVION International airmail postage is required if not mailed using the U.S. Postal Service, APO/FPO/DPO system, or diplomatic pouch. OFFICIAL ABSENTEE BALLOTING MATERIAL – FIRST CLASS MAIL NO POSTAGE NECESSARY IN THE U.S. MAIL – DMM 703.8.0 To (Fill in the address of your election office. The address can be found online at FVAP.gov.)