Absentee ballot request

John Peplinski;

3550 Bobwhite Ct.   

Melbourne, FL 32904

 

This is a request for an absentee ballot for the FSHPA Inc. officer’s election to be held in Clearwater, FL, April 25/26, 2008.  Absentee ballots must be requested prior to March 25, 2008 and the returned absentee ballots must be post marked no later than April 5, 2008.  Requests for absentee ballots must pass through the US postal system.

 

NAME:   ______________________________________________________

 

STREET ADDRESS: ____________________________________________

 

CITY: ________________________________________________________

 

STATE:    __________________     ZIPCODE _______________________

 

SIGNATURE: _________________________________________________

 

NHPA CARD NUMBER:  _______________________________________

All information must be supplied.  If the address above is different than the address currently in the FSHPA Inc. database, this request will be considered as a change of address.