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NJ Division of Elections - 1/2012

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Handdeliverto:

OfceoftheCountyClerk,Elec

tionDivision,

CountyAdministrationBuilding

600MarketStreet,Suite316,CamdenNJ

08102

APPLICATION FOR VOTE BY MAIL BALLOT

PLACE

POSTAGEHERE

BEFORE

MAILING

Name

Street Address

City, State, Zip Code

_________________________________

_________________________________

_________________________________

John S. Hogan

Bergen County Clerk

One Bergen County PlazaRoom 130

Hackensack, NJ 07601