Special Election Board Request Form
• Eligible registered voters must provide identification to the Special Election Board in order to vote a ballot (A.R.S. § 16-579)
• All requests must be made by 5:00 p.m. on the second Friday before the Election (A.R.S. § 16-549(C))
• Qualified electors who become ill or experience an emergency after 5:00 p.m. on the second Friday preceding the election and before 5:00 p.m. on the Monday immediately preceding the election may request a ballot subject to the accommodation of the County Recorder or other officer in charge of Elections to be delivered in person. In addition to providing identification, the voter shall sign a statement under penalty of perjury that states that the person is experiencing or experienced an emergency pursuant to (A.R.S. §16 549- (D))
𝗦𝗽𝗲𝗰𝗶𝗮𝗹 𝗘𝗹𝗲𝗰𝘁𝗶𝗼𝗻 𝗕𝗼𝗮𝗿𝗱 𝗜𝗺𝗽𝗼𝗿𝘁𝗮𝗻𝘁 𝗗𝗮𝘁𝗲𝘀 𝗮𝗻𝗱 𝗜𝗻𝗳𝗼𝗿𝗺𝗮𝘁𝗶𝗼𝗻
These requests are intended for voters who are ill or have a disability that prevents them from going to vote at the polls on the day of the election or has an event that causes illness or disability after the cutoff date to request an early ballot.
The Special Election Board will go to the voter’s residence or place of confinement and deliver a ballot. The Special Election Board will deliver the completed ballot to the Recorder’s office.
For partisan elections, the board must consist of two people, one from each of the two political parties which cast the highest number of votes in the state in the last preceding general election. For nonpartisan elections, the board will consist of two members from 2 different parties or affiliations.
The first day to submit a Special Election Board requests is 93 days before the election, which is May 3, 2020 for the Primary Election.
The last day to accept a Special Election Board requests is 5:00 pm on the second Friday before the election (11 days before the election) which is July 24, 2020 for the Primary Election.
For those that become ill or disabled after 5:00 pm on the second Friday before and through 5:00 pm on the day of the election may submit a Special Election Board request. The Recorder will accommodate such requests if possible.
O͟p͟t͟i͟o͟n͟s͟ f͟o͟r͟ t͟h͟o͟s͟e͟ t͟h͟a͟t͟ a͟r͟e͟ i͟l͟l͟ o͟r͟ d͟i͟s͟a͟b͟l͟e͟d͟ a͟n͟d͟ c͟a͟n͟n͟o͟t͟ v͟o͟t͟e͟ a͟t͟ t͟h͟e͟ p͟o͟l͟l͟s͟ i͟n͟ p͟e͟r͟s͟o͟n͟:
• Sign up for permanent early voting. An early ballot will automatically be mailed 27 days before each election in which you are eligible to vote in. If necessary, a caregiver may assist you in completing the ballot and either return the ballot to one of the Recorder’s Offices or drop it in the mail for you.
• Vote early in person at any one of the Recorder’s Offices. (
• Submit a request for an early ballot to be mailed to your residence or place of confinement no later than 11 days before an election.(
• Submit a Special Election Board request to have a ballot delivered by a Special Election Board no later than 11 days before an election. *Upon delivery of ballot to the voter by the Special Election Board, the voter must provide identification as listed in A.R.S 16-579(A)*
Date of Birth
Location where voter would like the Special Election Board to deliver the ballot.
Where voter is registered.
May be needed to contact you to help schedule the Special Election Board.
Preferred date and time to schedule the Special Election Board.
Reason for requesting Special Board
Have you tested positive for COVID-19?
This is for board members to take appropriate protocols when delivering ballot (will be confidential)
If request approved, I am aware that upon delivery of a ballot by the special election board, I must provide identification as listed in A.R.S 16-579(A).
Page 1 of 1
Never submit passwords through Google Forms.
This form was created inside of Pinal County Government.