11/21/2019

Dear Carla

Thank you for using the New York Overseas and Military Voter Services site to generate your Voter
Registration/Ballot Request form. Please follow the instructions below to complete the application process.
 

Please follow the instructions below to complete the application process.  

Fields left blank on your form are not required. Our registration system has prompted you for the
information that New York (NY) state requires only.  

Please print and check all your documents:

Verify that the data you entered is correct on your Voter Registration/Absentee Ballot Request form
and the accompanying Addendum page.

If corrections are needed, return to the NY website, https://newyork.overseasvotefoundation.org to

either: 1) access your Voter Account and regenerate the form with corrections or; 2) if your browser
is still open with the same session running, go back and make changes, then reprint or; 3) run through
the registration program again and reprint your form.

Print, sign and date the forms:

Sign and date your Voter Registration/Absentee Ballot Request form and Addendum page.

Make sure to date the forms in U.S. format - Month/Day/Year.

Your election office needs your original signature in order to process and approve your application.

Address your mailing envelope to:

Pasco County Elections Office, Pasco County
PO BOX 300
DADE CITY, FL 33526-0300
USA

Sending your documents:

The completed form contains your personal identity information and should be carefully transmitted to
your local election office.

Consult the NY State Voter Information Directory online for the various options for sending your Voter
Registration/Ballot Request form (see sidebar of our website).
 

Further information and resources:

The New York Overseas and Military Voter Services site provides many services that may be useful to you
over the course of this election period including:

My Voter Account™ - take advantage of this service, which makes it possible to keep an up-to-date
voter profile on hand, maintain your mailing list profile, generate a new ballot request form or a write-
in ballot with the click of a button.

Federal Write-in Absentee Ballot wizard - the Federal Write-in Absentee Ballot finally made easy! This
is a blank ballot for registered voters to use in the event that your ballot is late in arriving to you.

Voter Help Desk™ - fast and friendly answers to your voting questions.

Election Official Directory™ - a comprehensive listing of NY election office contact information.

State-specific Voter Information Directory™ - details on deadlines, voter materials transmission

options and state contact information.

Your next steps:

1. Send in your signed, dated, original form by regular mail.

2. Confirm that you are on the voter rolls and will receive your ballots:

We recommend that you contact your election official after sending your registration/ballot request
form to confirm that you are on the rolls and will receive your ballots this election year.

Your overseas voting contact:

Katy Abbitt-Hartnett
Phone: (800) 851-8754
Fax: (352) 521-4127
Email: khartnett@pascovotes.com

Your local election official:

Brian Corley
Phone: (800) 851-8754
Fax: (352) 521-4319
Email: bcorley@pascovotes.com

 
 Never take for granted that your ballot will simply arrive for the next election without confirming it.
Contact your election official and avoid surprises.  

Ballot back-up plan:

Sometimes ballots arrive late. Or not at all. We hope that does not occur in your case. If you don't receive
your requested ballot from your election office by 30 days before the election, please visit our site to
access the Federal Write-in Absentee Ballot wizard.

Thank you:

We wish you a positive voting experience in the coming election,  

New York State Board of Elections  

Voter Registration and This form is for absent Uniformed Service members,
Absentee Ballot Request their families, and citizens residing outside the United
States. It is used to register to vote, request an
Federal Post Card Application (FPCA)  absentee ballot, and update your contact information.
See your State’s instructions at FVAP.gov.
Print clearly in blue or black ink. 
1. Who are you? Pick one.
 I am on active duty in the Uniformed Services or Merchant Marine -OR-    I am an eligible spouse or dependent. 
I request an absentee   I am an activated National Guard member on State orders. 
ballot for all elections  ✔  I am a U.S. citizen living outside the country, and I intend to return. 
in which I am eligible 
to vote AND:   I am a U.S. citizen living outside the country, and my return is uncertain. 
 I am a U.S. citizen living outside the country, and I have never lived in the United States. 
✔
Female 
Last name  Linares Suffix (Jr., II) Sex
Male 
First name  Carla Previous names (if applicable) 
 
Middle name  Birth date (MM/DD/YYYY)  12 /  08 / 1985
 
Social Security Number  X X X X X 9 6 6 3 Driver’s license or State ID # 

2. What is your address in the U.S. State or territory where you are registering to vote and requesting an absentee ballot?
Your voting materials will not be sent to this address. See instructions on other side of form. 
Street address  8515 viva via Dr Apt # 
City, town, village  Hudson State   FL
County  Pasco County ZIP  34667
3. Where are you now? You must give your CURRENT address to receive your voting materials.
Your mailing address. (Different from above)  Your mail forwarding address. (If applicable) 
2740 South Rd Jr. Juan alfaro 274
Poughkeepsie, New york 12601
United States Miraflores, Lima 018
Peru

4. What is your contact information? This is so election officials can reach you about your request.
Provide the country code and area code with your phone and fax number. Do not use a Defense Switched Network (DSN) number.
Email:  calg85@hotmail.com Phone:  0 1 1 5 1 9 4 3 8 8 7 5 1 9
Alternate email:  Fax:

5. What is your voting preference? Select One.

How do you want to  ✔
Mail 
What is your political party  
receive voting materials   Email or online 
for primary elections?
from your election office? Fax
6. What additional information must you provide?
The following need more information: Alaska, Arizona, Puerto Rico, Vermont, and Virginia. (Ex. Proof of residency, employer, etc.)
   
You may also use this space to clarify your voter information. See the Voting Assistance Guide at FVAP.gov. 

Please send ballots to me at the indicated address For all elections this calendar year, including
primaries, general and special elections

7. You must read and sign this statement.

I swear or affirm, under penalty of perjury, that:
The information on this form is true, accurate, and complete to the best of my knowledge. I understand that a material misstatement of fact in  
completion of this document may constitute grounds for conviction of perjury. 
 
I am a U.S. citizen, at least 18 years of age (or will be by the day of the election), eligible to vote in the requested jurisdiction, and 
I am not disqualified to vote due to having been convicted of a felony or other disqualifying offense, nor have I been adjudicated mentally
incompetent; or if so, my voting rights have been reinstated; and 
I am not registering, requesting a ballot, or voting in any other jurisdiction in the United States, except the jurisdiction cited in this voting form.  

Sign here X Today’s date

(MM/DD/YYYY)
/
11/21/2019 / 
This information is for official use only. Any unauthorized release may be punishable by law. Previous editions are obsolete.              Standard Form 76 (Rev.09-2017), OMB No. 0704-0503 
You can vote wherever you are. Agency Disclosure Statement 
The public reporting burden for this collection of 
1. Fill out your form completely and accurately. information is estimated to average 15 minutes 
per response, including the time for reviewing 
instructions, gathering and maintaining the 
   
   Your U.S. address is used to determine where you are eligible to vote  data needed, and completing and reviewing the 
absentee. For military voters, it is usually your last address in your  collection of information. Send comments regarding 
State of legal residence. For overseas citizens, it is usually the last  this burden estimate or any other aspect of this 
collection of information, including suggestions for 
place you lived before moving overseas. You do not need to have any  reducing the burden to: Department of Defense, 
current ties with this address. DO NOT write a PO Box # in section 2. Washington Headquarters Services, Executive
Services Directorate, Information Management 
       
   Most States allow you to provide a Driver’s License number or the last  Division, 4800 Mark Center Dr., East Tower, Suite 
03F09, Alexandria, VA 22350-3100. [OMB Control
4 digits of your SSN. Some States require a full SSN. See your State’s  #0704-0503]. Respondents should be aware that 
guidelines at FVAP.gov.  notwithstanding any other provision of law, no 
person shall be subject to any penalty for failing 
   Most States require you to specify a political party to vote in primary  to comply with a collection of information if it does 
elections. This information may be used to register you with a party.  not display a currently valid OMB control number. 
DO NOT RETURN YOUR FORM TO THE ADDRESS 
   We recommend that you complete this form every year while you are  ABOVE. 

an absentee voter.  Privacy Act Statement 
 
Authority: The authority to collect your personal 
information on this form comes from 52 U.S.C. § 
2. Remember to sign this form! 20301, “Uniformed and Overseas Citizens Absentee 
Voting Act (UOCAVA).” 

3. Remove the adhesive liner from the top and sides. Principal purpose: This form serves as an 
application for registration and/or request for an 
   
Fold and seal tightly. absentee ballot for all persons covered by UOCAVA. 

   You can find the address for your election office at FVAP.gov.
   All States accept this form by mail, but they vary on email and fax.
See your State’s rules in the Voting Assistance Guide at FVAP.gov. 
Routine use(s): There is no retention of this 
information by the Federal government. Completed  
forms are sent by you to an appropriate State 
election official.
Disclosure: Your disclosure of personal information 
is voluntary. However, failure to provide the 
requested personal information may keep the 
pertinent jurisdiction from processing this request 

Questions? Email vote@fvap.gov and may prevent you from voting absentee. 

                        

From U.S. Postage Paid 
(Your name and mailing address) 39 USC 3406 
Linares, Carla
PAR AVION 
Jr. Juan alfaro 274
Miraflores, Lima 018
Peru

International airmail postage is required if not mailed using the 
U.S. Postal Service, APO/FPO/DPO system, or diplomatic pouch. 

OFFICIAL ABSENTEE BALLOTING MATERIAL – FIRST CLASS MAIL 
NO POSTAGE NECESSARY IN THE U.S. MAIL – DMM 703.8.0 
To
(Fill in the address of your election office.
The address can be found online at FVAP.gov.)

Pasco County Elections Office, Pasco County

PO BOX 300
DADE CITY, FL 33526-0300
USA
 ADDENDUM
REGISTRATION AND ABSENTEE BALLOT REQUEST - FEDERAL POST CARD APPLICATION (FPCA)

Name: Carla Linares

Contact Information: calg85@hotmail.com 011 51 943 887 519
State: FL
County: Pasco County
4. ADDITIONAL INFORMATION

I last registered and voted on Election Day in Pasco, Florida.

I do solemnly swear (or affirm) that I will protect and defend the Constitution of the United States and the Constitution of the State
of Florida, that I am qualified to register as an elector under the Constitution and laws of the State of Florida, and that all
information provided in this application is true.
_____________________________________________
Please add me to your Federal Overseas and Military Absentee Voter Mailing List. I would like to be kept informed by your office
on important voting news.

Signed: Date: 11/21/2019 Signed: NOT REQUIRED Date:

(MMDDYYYY) (Witness/Notary and Address (if required)) (MMDDYYYY)