Address Confirmation Notice Reply Form

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Please use this form if you have received an Address Confirmation Request, an Address Change Notice or an Address Confirmation Final Notice from our office and you wish to confirm you have NOT moved out of the county.

You can use this form if both of the following statements are true.

Your name is correct on the notice
You continue to maintain your legal residence in this county

Otherwise, if you have changed your name or you have moved elsewhere within the state of Florida, you can not use this form and instead must use the official Florida Voter Registration Form to update your registration information.

Finally, if you have moved your legal residence outside the state of Florida and wish to have your Florida voter registration cancelled, please sign and return the confirmation notice that you received.

Fields marked with a red asterisk are required.

First Name

Middle Name or Initial

Last Name

Date of Birth

Florida Voter Registration Number (if known)

Phone Number

E-mail Address

No permenent address?

Check here if you do not have a permanent address in this county and are living outside the county but intend to remain a permanent resident of this county. Leave the Current Residence Address (next field) blank.

Current County Residence Address

Previous County Residence Address

Mailing Address

Previous Mailing Address

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