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Full Legal Name * Date of Birth (mm/dd/yyyy) *

Residential Address (street, city, ZIP) *

Phone # * Email

County of Voter Registration * Election Date *

I can serve during * Preferred Location

I certify I am a qualified and registered voter of the county listed above. I certify I am not a candidate, sheriff, deputy sheriff, police officer, or other law enforcement officer.

Poll watchers are designated with the Supervisor of Elections on Form DS-DE 125 by a candidate, political party, or political committee. Submitting this form volunteers you for designation; RACC handles the official filing. This information becomes part of a public record once filed. Deadlines: Early Voting — noon at least 14 days before EV begins; Election Day — noon of the 2nd Tuesday before the election.

A local action organization providing ongoing information, community updates, and opportunities for civic engagement for the residents of Charlotte County, Florida.

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