Governance Referendum Voting Form

Governance Referendum Voting Form
Governance Referendum Voting Form for recording referendum ballot choices and basic verification details.
Voter Information
Full Name
First NameMiddle NameLast Name
Residential Address or Constituency/Ward
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Contact Email
example@example.com
Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Referendum Ballot
Referendum Name or Issue Title
Voting District or Precinct
Proposition 1 Vote
Proposition 2 Vote
Declaration and Submission
Submission Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Confirmation
Submission Notice
Should be Empty: