North Carolina Absentee Ballot Request Form ‘taco County Board of Elections
November 3, 2020
Read instructions before comptating this form,
‘5 West Main Sheet Frankin. NC 26734
Identification = 2
Required
feasaamaconne org
. 28340-2008 (9) 6283492557 ()
Voter T st Name ts
Vater ion Last Neme Meadows: First Neme Mark
Required Miadie Name Randal ‘Sul (4, Se. IV)
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Or Lest four digts of voters Socil Secunty number
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re Maiing Addvess 1023 N Royal Street #302
| Alexandria, VA 22314
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Di Fex number
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Signature ° Gaehere
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"FRAUDULENTLY GR FALSELY COMPLETING THIS FORM IS A CLASS | FELONY UNDER CHAPTER 163 OF THE NC GENERAL STATUTES