Remote Accessible Ballot

First Name

Last Name

Drivers License or ID

Social Security Number (Last 4 Digits)

Residence Address

Apartment / Unit Number

Election

Birthdate

Street Number

Street Name

Street Type

City Name

Zip Code

For the June 2, 2026, Statewide Direct Primary Election, all registered voters in California are eligible to use this accessible vote-by-mail system.
• I am a registered California voter; therefore, I am eligible to use this accessible vote-by-mail system.
• I understand that my ballot selections marked by this system must be printed by me and submitted in a signed return envelope to my county elections official, County of Santa Clara, no later than 8:00 p.m. Pacific Standard Time on June 2, 2026 - Election Day - by any of the following methods:
- Mailing it with a postmark on or before June 2, 2026; or
- Hand delivering it to the office of my county elections official; or
- Dropping it off at any polling place, vote center, vote-by-mail drop-off location, or drop box in the state; or
- Returning by fax for military (living outside the territorial limits of the United States) and overseas voters (UOCAVA) only.
• I understand that my ballot selections marked by this system and submitted to the County of Santa Clara will be transferred onto a ballot by an elections official to be tabulated.

I certify that all the above are true.