REQUEST FOR MAIL BALLOT
1-13.5-1105(4)(d), (e) C.R.S.

To:	Designated Election Official

	                                                              District

I,                                                                            , whose birth year is                                , and 

who reside at                                                                             ,    Boulder   County, 

Colorado, hereby swear (or affirm) that I am an eligible elector of the   Nederland Fire Protection               

District. I am registered to vote pursuant to the “Colorado Uniform Election Code of 1992” and I am:
	_____ 	A resident of the District; or
	
_____ The owner (or spouse or civil union partner of an owner) of taxable real or 
personal property situated within the boundaries of the District.  A person who is 
obligated to pay taxes under a contract to purchase taxable property within the 
District shall be considered an owner of taxable property for the purpose of qualifying as an elector.

	Physical address or description of property:							
										
I am requesting a mail ballot for the regular election of the District to be held on May 5, 2020, because (check one):
	_____ I did not receive the original mail ballot.
	_____ The ballot was destroyed or lost, or for some other reason not received by me.
	_____ I spoiled the original ballot.
_____ I am the spouse or civil union partner of                                                   , a property owner within the District.  
_____ A mail ballot packet was not sent to me, because my voter eligibility could not be determined at the time the mail ballot packet were mailed. 

_____I am personally receiving the ballot today, OR

	Please mail the mail ballot to me at the following address:  

I swear or affirm that I am requesting the mail ballot for the reasons stated above, that I have not voted the original ballot issued for the election indicated (if any), and I do not intend to vote at the election except by voting the ballot hereby issued.  

X                                                                                            
                      Signature							Date Signed

YOUR BALLOT MUST BE RECEIVED BY 7:00PM, ELECTION DAY, MAY 5, 2020, TO BE COUNTED.

Procedural Instructions: Check to determine whether the person was sent a ballot by checking poll book.
Determine voter eligibility by ensuring the requestor is registered to vote in Colorado; contact the Clerk & Recorder of the county the person states they reside in or SOS office. If identifying as a spouse or civil union partner, check Assessor’s list for the name indicated on this form if non-resident. Property must be owned by natural person. Do not provide a ballot unless eligibility is determined.

The first ballot returned by the voter will be considered the official ballot (§1-13.5-1105(7)), C.R.S.