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Person to our office in the courthouse; by mail: 100 S. Jefferson Ave, Suite 217, Eatonton, GA 31024; by fax: (706) 485-9684 (FAILURE TO FILL OUT THE FORM COMPLETELY COULD DELAY YOUR APPLICATION) PLEASE PRINT Date of Primary, Election or Runoff: / / 20 FOR PRIMARY ELECTIONS ONLY, CHOOSE A PARTY BALLOT (check one): APPLICATION DATE DATE OF BIRTH DAYTIME CONTACT NUMBER (optional) / / / / (NONPARTISAN RACES ONLY) DEMOCRATIC REPUBLICAN ( ).

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