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Your information will be kept strictly confidential, but we ask for this information so we may contact you with additional questions.
First Name
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Last Name
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Email Address
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Street Address Where You Are Registered to Vote
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City
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Zip
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Phone
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Were you told that "You already voted" when you attempted to vote?
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Yes
No
If you were told you already had voted, did you get to vote another ballot while the election's office investigated the issue?
Yes
No
Did you receive a ballot IN ERROR at your home? If so which of the following erroneous ballots did you receive at your household?
Duplicate Ballots for Same Person
Ballot for a Dead Person
Ballot(s) for Person(s) Who No Longer Lives Here
Ballot(s) for Person(s) Who Never Lived Here
What is the name of the voter(s) on the erroneous ballot(s)?
Did you have a long wait time at your polling station?
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Yes
No
How long was your wait?
Anything additional you want to report?
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