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Proxy Form - Douglas Co. Assembly
This form is for delegates who are not able to attend your House District Assembly and require a proxy.
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Email
*
Your email
Indira
*
Your answer
Enter your Last Name as it appears on your Driver's License/ID or your Voter Registration
*
Your answer
E-Mail of the Proxy Holder
*
Your answer
First Name of the Proxy Holder
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Your answer
Last Name of the Proxy Holder
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Your answer
Specific Voting Instructions (optional)
Your answer
Zip Code of the Proxy Holder
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Your answer
Precinct and House District of the Proxy Holder
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Your answer
Virtual signature *An electronic signature is acceptable. To sign electronically type your full name in the space provided below. No person may carry more than one proxy.
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Your answer
A copy of your responses will be emailed to the address you provided.
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