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Election Forms

ABSENTEE SERIES

 

Absentee Voter’s Bill of Rights

(Revised 11/09)

ABS-ATTORNEY GENERAL: Application for Absentee Ballot by Attorney General Program Participant

(State Form 55378; R8/2-19)

* Versions R7/19 and R6/10-17 may also be used.

ABS-IN PERSON: Application for Absentee Ballot in-Person Only

(State Form 42106; R29/2-19)

* Versions R28/19 and R27/10-17 may also be used.

AUS-EN PERSONA Solicitud de Voto en Ausencia en Persona Unicamente (Spanish version)

(State Form 53369; R14/2-19)

* Versions R13/1-29 and R12/10-17 may also be used.

ABS-MAIL: Application for Absentee Ballot by Mail Only in 2019

(State Form 47090; R26/2-19)

* Versions R25/3-19 R24/1-19, and R23/11-18 may also be used.

AUS-POR CORREO Solicitud de Voto en Ausencia por Correo Unicamente (Spanish version)

(State Form 53368; (5-19)

ABS-TRAVELING BOARD: Application for Absentee Ballot by Traveling Board

(State Form 55379; R3/10-17)

ABS-5: Statement Concerning Defective, Lost, Destroyed, or Spoiled Absentee Ballot

(State Form 47696; R9/10-17)

ABS-6: Absentee Ballot Security Envelope for Mailing Ballots

(State Form 47696; R5/7-14)

ABS-7: Absentee Ballot Security Envelope for Ballots Delivered by Traveling Board or Voted in Election Board Office

(State Form 49137; R7/11-14)

ABS-8: Absentee Ballot Outer Envelope

(State Form 49136; R3/12-06)

ABS-9: Cover Sheet and Affidavit for Absent Uniformed Service and Overseas Voter

(State Form 5129; R4/8-14)

ABS-10: Absentee Ballot Envelope for Uniformed Service or Overseas Voter’s Absentee Ballot

(State Form 51260; R3/11-09)
* Version R2/12-06 may continue to be used

ABS-11: Uniformed Services Voter Registration Certificate

(State Form 51261; R3/8-14)

ABS-13: Affidavit for Late Voter Registration by Absent Uniformed Services Voter

(State Form 51263; R15/11-18)

ABS-14: Notice of Disposition of Absentee Ballot Application by Military or Overseas Voter

(State Form 51624; R3/10-17)

ABS-16: Absentee Ballot Security Envelope for Mailing Ballots From Military and Overseas Voters

(State Form 51625; R2/7-14)

ABS-17: Affidavit of Individual Delivering Absentee Ballot Application to County

(State Form 52411; R2/11-14)

ABS-18: Notice to Absentee Voter to Supply Additional Documentation

(State Form 51631; R11/11-18)

ABS-19: Affidavit of Individual Delivering a Voter’s Marked Absentee Ballot to County

(State Form 52412; R/7-14)

ABS-20: Affidavit of County Election Board or Absentee Board Member Challenging Absentee Ballot Application

(State Form 52410; R2/7-14)

ABS-21: Certificate of Absentee Ballot Rejection or Failure to Timely Receive Absentee Ballot by Mail

(State Form 26710;(5-19)

ABS-22: Appointment and Oath of Office for Absentee Board Member, Absentee Ballot Courier, Absentee Ballot Counter, or Provisional Ballot Counter

(State Form 55433; R2/11-18)

Federal Postcard Combined [Absentee and Registration] Application (FPCA) (2017 revision)

MOVE Information Sheet for Military and Overseas Voters

 

CANDIDATE SERIES

CAN-1: Candidate Filing Challenge

(State Form 46437; R12/7-17)

Versions R11/7-17; R10/9-15 and R9/7-15 may continue to be used.

CAN-5: County Election Board Primary Candidacy Filing Confirmation for 2019

(State Form 46433 (R8/5-19)

CAN-6: Circuit Court Clerk’s or Election Director’s Certificate of Primary Election Candidate List

(State Form 46432; R4/12-02)

CAN-8: Indiana Petition for Presidential Primary Ballot Placement in 2020

(State Form 46435;(R11/5-19)

CAN-9: Legal Notice of Primary Election

(State Form 46430; R12/9-17)

CAN-12: Statement of Economic Interests for Local and School Board Offices

(State Form 55128; 11-12)

CAN-15: Call for Town Convention

(State Form 46421; R8/6-11)

CAN-16: Town Office Declaration of Candidacy by a Democratic, Libertarian, or Republican Candidate When No Town Primary is Conducted in 2019

(State Form 46422; R20/12-18)

CAN-17: Circuit Court Clerk Certification of Town Candidates

(State Form 46424; R12/11-10)

CAN-18: Town Convention Certificate of Nomination

(State Form 46423; R12/11-10)

CAN-22: 2019 Party Chairman Certification of Libertarian Party Nominees for County and Large Town Offices and Candidate’s Consent to Nomination

(State Form 49025; (R11/7-18)

CAN-25: Petition Primary Ballot Placement as a Candidate for Governor in 2020

(State Form 54518(R3/5-19)

CAN-39: Legal Notice of Municipal Election

(State Form 48110; R7/7-18)

CAN-40: Replacement of Candidate Nominated by Petition in 2019

(State Form 48518; (R14/6-18)

CAN-42: Declaration of Candidacy for Municipal Primary Nomination in 2019

(State Form 48870; R5/6-18)

CAN-43: Municipal Primary Election Candidate Withdrawal in 2019

(State Form 48891; R5/5-18)

CAN-44: Petition of Nomination for City or Town Office in 2019

(State Form 49024; R6/7-18)

CAN-45: Consent of Independent or Minor Political Party Candidate Nominated by Petition for a City or Town Office in 2019

(State Form 49027; R6/7-18)

CAN-46: Municipal Election Candidate Withdrawal in 2019

(State Form 49041; R7/7-18)

CAN-47: Call of Political Party Caucus to Fill an Early Ballot Vacancy for a City or Town Office

(State Form 49039; R2/12-06)

CAN-48: Declaration of Candidacy and Written Consent to Fill a Ballot Vacancy for a City or Town Office in 2019

(State Form 49038; R4/7-14)

CAN-49: Certificate of Candidate Selection to Fill an Early Ballot Vacancy for a City or Town Office in 2019

(State Form 49040; R5/7-18)

CAN-50: Certificate of Candidate Selection to Fill a Late Ballot Vacancy for a City or Town Office in 2019

(State Form 49036; R6/7-18)

CAN-51: Declaration of Intent to be a Write-In Candidate for City or Town Office in 2019

(State Form 49043; R5/7-14)

 

County Chairman Certification of Party Affiliation for a Primary Election Candidate

(NOTE: This is not a state-approved form, but is provided as a template for candidates and others to use when necessary as part of the candidate’s declaration of candidacy filing.)

CAMPAIGN FINANCE ADMINISTRATION SERIES

CFA-1: Candidate’s Statement of Organization and Designation of Principal Committee or Exploratory Committee

(State Form 4604; R15/5-19)

* Versions R14/10-17 and R13/11-05- may continue to be used

CFA-2: Political Action Committee or Legislative Caucus Committee Statement of Organization

(State Form 28251; R11/12-18)

* Versions R9/09 and R8/11-05 may continue to be used

CFA-3: Regular Party Committee Statement of Organization

(State Form 46413; R6/10-17)

* Versions R5/9-09 and R4/11-05 may continue to be used

CFA-4: Report of Receipts and Expenditures of a Political Committee

(State Form 4606; R15/5-19)

* Version R14/10-17, R13/11-05 may continue to be used

CFA-5: Notice of Contribution or Expenditure to Candidate’s Committee

(State Form 4761 (R6/11-01)

CFA-11: Supplemental “Large Contribution” Report by a Candidate’s Committee ($1,000 Contributions or More)

(State Form 48492; R6/5-19)

* Versions R5/10-17, R4/11-05 and R3/11-05 may continue to be used

 

INDIANA ELECTION COMMISSION SERIES

IEC-6: Indiana Voting System or Electronic Poll Book Disposal Plan

(State Form 56532; 6-18)

IEC-7: Request for Indiana Election Division Publications in 2019

(State Form 46736; R17/7-18)

IEC-8: Precinct Summary Statement

(State Form 13332; R7/7-06)

IEC-9: Certification of Test of Electronic Voting Systems

(State Form 54728; R3/5-19)

IEC-10: Certification of Test of Optical Scan Card Ballot Automatic Tabulating Machines

(State Form 47203; R10/5-19)

IEC-22: County Certification of Voting System and Electronic Poll Book Inventory

(State Form 56531; 5-18)

 

COUNTY ELECTION BOARD SERIES

CEB-1: Certificate of Delivery of Precinct Election Materials by Inspector and Judge

(State Form 47202; R4/11-05)

CEB-3: Certificate of Appointment Pro Tempore to Fill a Local Elected Office by a County Chairman of a Major Political Party

(State Form 47433; (R7/7-17)

Version R6/10-13 may continue to be used.

CEB-4: Certificate of Appointment Pro Tempore to Fill a Local Elected Office by a Precinct Committeeman Caucus

(State Form 47433; (R7/7-17)

Version R7/10-13 may continue to be used.

CEB-5: Declaration of Candidacy for a Vacant Local Office to be Filled by a Precinct Committeeman Caucus

(State Form 47729; (R5/7-17)

Version R4/12-02 may continue to be used.

CEB-6: Appointment and Oath of Office for County Election Board Member

(State Form 47857; (R410/12-03)

CEB-22: Certificate of Selection for Appointment Pro Tempore to Local Office

(State Form 48231; (R7/7-17)

Version R6/10-13 may continue to be used.

CEB-25: Statement of the Votes Cast for School Board Offices and on Local Public Questions

(State Form 48644; (R10/7-17)

CEB-26A: Certificate of Circuit Court Clerk Declaring Public Question to Reorganize Political Subdivisions Approved or Rejected

(State Form 55450; 10-13)

CEB-26B: Certificate of Circuit Court Clerk Declaring Public Question to Reorganize Municipality and Township Approved or Rejected

(State Form 55449; 10-13)

CEB-26C: Certificate of Circuit Court Clerk Declaring Public Question to Reorganize Municipality and County That Does Not Contain a Consolidated City Approved or Rejected

(State Form 55448; 10-13)

CEB-27:  Certificate of Election for Mayor

(State Form 49157; R5/7-18)

CEB-28:  Certificate of Election; City Common Council Member

(State Form 49161; R4/7-18)

CEB-29:  Certificate of Election; City-County Council Member

(State Form 49159; R5/7-18)

CEB-30:  Certificate of Election; City Clerk

(State Form 49158; R5/7-18)

CEB-31:  Certificate of Election; City Clerk-Treasurer

(State Form 49163; R5/7-18)

CEB-32: Certificate of Election; Town Clerk-Treasurer

(State Form 49162; (R14/7-18)

CEB-33: Certificate of Election; Town Council Member

(State Form 49164; (R15/7-18)

CEB-34: Apportionment of Municipal Primary Costs in Counties Using Precincts

(State Form 54704; R2/10-18)

CEB-35: Apportionment of Municipal General Election Costs in Counties Using Precincts

(State Form 51845; R2/10-18)

CEB-38: Apportionment of Municipal Primary Costs in Counties Using Vote Centers

(State Form 56606; 10-18)

CEB-39: Apportionment of Municipal General Election Costs in Counties Using Vote Centers

(State Form 56607; 10-18)

Certification of Death of Officeholder (2014)

 

PRECINCT SERIES

PRE-1: Precinct Oath Book

(State Form 42063; R12/5-19)

 

PRE-2: Statement of Expenses of Precinct Election Officers

(State Form 47432; R3/12-02)

PRE-3: Affidavits of Voter Assistance

(State Form 28192; R10/5-19)

PRE-4:    Affidavit of a Voter by a Challenger or Member of the Precinct Election Board/Affidavit of a Challenged Voter

(State Form 42132; R11/7-14)

*The PRE-4 must be printed directly on the PRO-2 Provisional Ballot Security Envelope.

PRE-5:    Voter’s Affidavit Requesting to Vote in Person at Polls After Failing to Receive Mailed Absentee Ballot

(State Form 55876; R/10-15)

PRE-6: Affidavit to Challenge a Person at a Primary Election Due to Party Affiliation

(State Form 42130; R8/12-05)

PRE-7: Qualified Elector’s Affidavit Disqualifying a Precinct Election Officer

(State Form 42131; R7/10-15)

PRE-8: Appointment of Replacement Precinct Election Officer

(State Form 47930; R4/12-05)

PRE-10: Inspector’s Affidavit for Return of Ballot and Supplies

(State Form 47929; R5/12-05)

PRE-11: General Election Certificate and Memoranda of Total Votes Cast in a Precinct

(State Form 47921; R6/12-05)

PRE-12: Voter Registration Affidavit Envelope

(State Form 47936; R2/12-01)

PRE-13: Grand Jury Affidavits Envelope

(State Form 47937; R8/5-19)

PRE-15: Miscellaneous Forms Envelope

(State Form 47940; R4/12-06)

PRE-16:  Inspector and Judge’s Report of Total Number of Votes Cast on Electronic Voting Systems in Precinct and Number of Voters Who Received Ballot at Precinct as indicated by Signing Poll List

(State Form 56529; 6-18)

PRE-17: Primary Election Certificate and Memoranda of Total Votes Cast in a Precinct

(State Form 48885; R5/12-05)

PRE-18: Municipal Election Certificate and Memoranda of Total Votes Cast in a Precinct

(State Form 49037; R2/12-06)

PRE-19:  Affidavit of a Public Safety Officer or Member of the Military Returning to the Polls to Vote After Responding to an Emergency

(State Form 54510; 11-10)

Pollbook and E-pollbook Notice to Voters (2015)

 

PROVISIONAL VOTING SERIES

PRO-1: Provisional Ballot Retention Envelope

(State Form 54856 (11-11)

*A previously approved version of this form which does not include a state form number may continue to be used.

PRO-2: Provisional Ballot Security Envelope with PRE-4 affidavits attached

(State Form 51618; R3/11-09)

PRO-3: Provisional Ballot Package Label

(State Form 51630; R10/8-18)

PRO-4: Provisional Ballot Outer Envelope

(State Form 51615; R/8-14)

PRO-5: Provisional Ballot Envelope for Ballots Issued After Regular Poll Closing Hours

(State Form 51616; 2-04)

PRO-6: Provisional Ballot Envelope for Spoiled Provisional Ballots

(State Form 51617; 2-04)

PRO-7: Provisional Ballot Envelope for Rejected Provisional Ballots

(State Form 51629; 2-04)

PRO-8: Provisional Ballot Counter Oath

(State Form 51628; 2-04)

PRO-9: Instructions to Provisional Voter

(State Form 51626; R3/10-13)

PRO-10: Affidavit of Challenged Voter Concerning Proof of Identification Requirement

(State Form 52432; R4/7-14)

PRO-11: Affidavit of Challenged Voter Concerning Proof of Identification Requirement in a Municipal Election

(State Form 52433; R3/7-14)

 

VOTER REGISTRATION SERIES

A voter registration form authorized by United States Postal Service regulations to include the “Official Mail Logo” may do so.

VRG-1: County Sheriff Quarterly Report to County Voter Registration Office

(State Form 56337; 7-17)

VRG-4/12 : Affidavit of Request for Transfer of Voter Registration at the Time of Requesting a Ballot

(State Form 28186; R13/8-14)

VRG-7: Indiana Registration by Mail Application

(State Form 50504; R18/3-19)

* Versions R17/2-19, R16/1-19; R15/12-18; R14/10; R13/8-16; R 12/4-16; R11/3-16, R10/9-14, and R10/9-13 may also be used.

VRG-7: Solicitud de Registro para el Votante de Indiana (Spanish language form)

(State Form 54509; R11/3-19)

* Versions R10/1-19, R9/12-18, R8/10-17; R7/8-16; R6/4-16; R 5/3-16, R4/9-14, and R3/10-13 may also be used.

VRG-8: Indiana Voter Registration Material Receipt

(State Form 46927; R9/5-19)

VRG-9: Indiana Voter Registration Transmittal

(State Form 46928; R9/5-19)

VRG-11: Indiana County Voter Registration Application

(State Form 46965; R12/9-13)

VRG-11: Solicitud de Registro para el Votante del Condado (Spanish language form)

(State Form 55442; 10-13)

VRG-14: Authorization to Cancel Registration

(State Form 47363; R3/12-01)

VRG-21: Affidavit of County Voter Registration Officer Concerning Voter List Maintenance

(State Form 47858; R7/10-17)

VRG-24: Application for County Voter Registration Computerized Data

(State Form 48648; R4/10-13)

Precinct “Vote Here” poster

(State Form 47943; R/12-01)

Federal Voter Registration Form (US Election Assistance Commission)

Federal Postcard Combined [Absentee and Registration] Application (FPCA) (2017 revision)