Replacement Ballot Request Form

This form is only for voters who are currently registered to vote in Pierce County, Washington.

If you are not currently registered, please go to vote.wa.gov to become a registered voter.

If you misplaced or did not receive your ballot, or simply made an error and wish to receive a replacement ballot, fill out the form below and a replacement ballot will be sent to you.

Name

Current Pierce County Residence Address or "Home of Record"


City


State Zip Code Phone


Date of Birth (MM/DD/YYYY)


Email Address

Mailing Address (if different from above)


City


State Zip Code Country

Please provide reason for request below:
(didn't receive ballot, made mistake, etc...)