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Provisional Ballot Signature Cure Affidavit Instructions and Form

READ THESE INSTRUCTIONS CAREFULLY BEFORE COMPLETING THE AFFIDAVIT.
FAILURE TO DO SO MAY CAUSE YOUR BALLOT NOT TO COUNT.

You were referred to these instructions and affidavit either because you did not sign your provisional ballot envelope or because the signature on your provisional ballot envelope does not match our records. Your ballot cannot be counted unless we receive your signed affidavit and a copy of your identification by 5:00 p.m., the 2nd day after the election.


1. Read and fill out the provisional ballot cure affidavit:  English | Spanish

a. print your name

b. print your address

c. sign your name

 

2. Make a COPY of ONE of the following forms of identification:

Current and valid identification that includes your name and photograph:

- Florida driver’s license

- Florida identification card from the Department of Highway Safety and Motor Vehicles

- United States passport

- Debit or credit card

- Military identification

- Student identification

- Retirement center identification

- Neighborhood association identification

- Public assistance identification

- Veteran health identification card issued by the United States Department of Veterans Affairs

- Florida License to carry a concealed weapon or firearm

- Employee identification card issued by any branch, department, agency, or entity of the Federal Government, the state, a county, or a municipality

 

OR Identification that shows your name and current residence address:

- Current utility bill

- Bank statement

- Government check

- Paycheck

- Government document (excluding voter information card)

 

3. In a mailing envelope addressed to the Supervisor of Elections, enclose your signed affidavit and the COPY of your identification.

4. Mail or deliver the envelope to any of the offices of the Supervisor of Elections below.

Or you may fax your affidavit and scanned copy of identification to 321-633-2130 or email them to provisional@votebrevard.com. If emailing, include the documents as attachments.


YOUR SIGNED AFFIDAVIT AND COPY OF YOUR IDENTIFICATION MUST BE RECEIVED NO LATER THAN 5:00 P.M., THE SECOND DAY AFTER THE ELECTION

 AT ONE OF MY FOUR ELECTION OFFICES:

Titusville: 400 South Street, Titusville, FL 32780

Viera: 2725 Judge Fran Jamieson Way, Melbourne, FL 32940

Melbourne: 1515 Sarno Road, Melbourne, FL 32935

Palm Bay: 450 Cogan Drive SE, Palm Bay, FL 32909

Office hours are Monday-Friday, 8:00 a.m. - 5:00 p.m.

 

If you have any questions, call the provisional ballot department at 800-579-4780.

PROVISIONAL BALLOT CURE AFFIDAVIT  English | Spanish