Date of Birth. / / (Month/Day/Year) Fill out Section 2 and make sure the street address is the physical address where you are registered to vote.

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1 VOTE BY MAIL IN IOWA Voting is simple and in Iowa, you can even do it from the comfort of your own home. Just follow the steps below, and you ll be on your way to voting by mail. Take a look at the examples provided, sign your form, find the address of your county auditor in the list below, and then drop it in the mailbox. STEP 1 (OPTIONAL): Fill out Section 1 with either your driver s license or, if you do not have a driver s license, the last four digits of your Social Security Number. STEP 2: Fill out your date of birth. Official Absentee Ballot Request Form 1. If you don t have an Iowa driver s license or non-operator ID, provide the last 4 digits of your Social Security Number. Valid IA Driver s License or IA Non-Operator ID Number Last 4 Digits of SSN # OR STEP 3: Date of Birth / / (Month/Day/Year) FOR OFFICE USE ONLY Fill out Section 2 and make sure the street address is the physical address where you are registered to vote. Name Last Name First Name Middle Name Suffix ( Sr., Jr., etc.) 2. Street Address (include apt., lot, etc., if applicable) City State ZIP Daytime Phone, Cell Phone or STEP 4: If you have moved within your county: Check box Number 3 and your voter registration record will be updated. If you have moved to a new county: You must complete a new voter registration form for that county. Visit to complete a new voter registration form. 3. I have moved. The above address represents my NEW address. Please change my voter record accordingly. STEP 5 (OPTIONAL): If you want your ballot sent to a different address, put that information in Section Complete section #4 ONLY if the ballot is to be mailed to an address different than the address in section #2. Mailing Address (include apt., lot, etc., if applicable) City State ZIP Country (other than USA) STEP 6: Sign and date. 6. X Signature of Voter Date STEP 7: Once you have successfully completed the form, find your county auditor below, and send the form address listed. 1

2 ABSENTEE BALLOT REQUEST FORM State of Iowa Official Absentee Ballot Request Form If you don t have an Iowa driver s license or non-operator ID, provide the last 4 digits of your Social Security Number. Valid IA Driver s License or IA Non-Operator ID Number Last 4 Digits of SSN # OR Date of Birth / / ( Month / D a y / Y e a r ) Name Last Name First Name Middle Name Street Address (include apt., lot, etc., if applicable) Form 3A (Rev 01-08) City State ZIP Daytime Phone, Cell Phone or REQUIRED Information FOR OFFICE USE ONLY Suf x ( Sr., Jr., etc.) I have moved. Complete section #4 ONLY if the ballot is to be mailed to an address different than the address in section #2. Mailing Address (include apt., lot, etc., if applicable) City The above address represents my NEW address. Please change my voter record accordingly. State Former Name (if applicable) ZIP Country (other than USA) / 06 / 12 Date of the Election OR Name of the Election for this Absentee Ballot Request ( Mon t h / D a y / Y e a r ) Check only ONE Box X General Primary School City Special Party Affi liation Democratic (for Primary Elections Only) Republican NOTE: If your voter registration record shows a political party different from the one you check above, your registration will be changed to the political party you check on this form. 6. X Signature of Voter Date

3 LIST OF COUNTY AUDITORS ADAIR COUNTY Mindy Schaefer MAILING ADDRESS: 400 Public Square Suite 5, Greenfield, IA PHONE: ADAMS COUNTY Nancy Carmichael MAILING ADDRESS: PO Box 28, Corning IA PHONE: ALLAMAKEE COUNTY Pam Benjegerdes MAILING ADDRESS: 110 Allamakee St, Waukon, IA PHONE: APPANOOSE Linda Demry MAILING ADDRESS: 201 N. 12th Street, Centerville IA PHONE: AUDUBON Lisa Frederiksen MAILING ADDRESS: 318 Leroy St #4, Audubon, IA PHONE: BENTON Jill Marlow MAILING ADDRESS: PO Box 549, Vinton IA PHONE: BLACK HAWK Grant Veeder MAILING ADDRESS:316 East 5th Street, Waterloo, IA PHONE: BOONE Phil Meier MAILING ADDRESS: 201 State Street, Boone, IA PHONE: BREMER Shelley Wolf MAILING ADDRESS: 415 E. Bremer Avenue, Waverly, IA PHONE: BUCHANAN Cindy Gosse MAILING ADDRESS: PO Box 317, Independence IA PHONE: BUENA VISTA Sue Lloyd MAILING ADDRESS: PO Box 220, Storm Lake IA PHONE: BUTLER Holly A. Fokkena MAILING ADDRESS: PO BOX 325, Allison, IA PHONE: CALHOUN Judy Howrey MAILING ADDRESS: 416 Fourth Street, Suite 1, Calhoun County Courthouse, Rockwell City, IA PHONE: CARROLL Joan Schettler MAILING ADDRESS: 114 E. 6th St., Carroll, IA PHONE: CASS Dale E. Sunderman MAILING ADDRESS: 5 West 7th Street, Atlantic, IA PHONE: CEDAR Cari Gritton MAILING ADDRESS: 400 Cedar Street, Tipton, IA PHONE: CERRO GORDO Kenneth Kline MAILING ADDRESS: 220 North Washington Avenue, Mason City, IA PHONE: CHEROKEE Kris Glienke MAILING ADDRESS:520 West Main, Drawer H, Cherokee, IA PHONE: CHICKASAW Joan Knoll MAILING ADDRESS: P.O. Box 311, New Hampton, IA PHONE: CLARKE Judy Church MAILING ADDRESS: 100 S. Main, Osceola IA PHONE: CLAY Marjorie A. Pitts MAILING ADDRESS: 300 W 4th St. Ste. 4, Spencer, IA PHONE:

4 CLAYTON Dennis Freitag MAILING ADDRESS: PO Box 416, Elkader IA PHONE: DES MOINES Carol S. Copeland MAILING ADDRESS: PO Box 784, Burlington, IA PHONE: FREMONT Joan Kirk MAILING ADDRESS: 506 Filmore Street, Sidney, IA PHONE: CLINTON Eric Van Lancker MAILING ADDRESS: PO BOX 2957, Clinton, IA PHONE: DICKINSON Nancy Reiman MAILING ADDRESS:1802 Hill Ave Suite 1400, Spirit Lake, IA PHONE: GREENE Jane Heun MAILING ADDRESS: 114 N. Chestnut Street, Jefferson, IA PHONE: CRAWFORD Terri Martens MAILING ADDRESS: 1202 Broadway, Suite 5, Denison, IA PHONE: DUBUQUE Denise M. Dolan MAILING ADDRESS: 720 Central Avenue, Dubuque, IA PHONE: GRUNDY Rhonda R. Deters MAILING ADDRESS: 706 G Avenue. Grundy Center, IA PHONE: DALLAS Gene Krumm MAILING ADDRESS: 910 Court Street, Adel, IA PHONE: EMMET Michele Erickson MAILING ADDRESS: 609 1st Avenue North, Estherville, IA PHONE: GUTHRIE Jerri Christman MAILING ADDRESS: 200 North 5th Street, Guthrie Center, IA PHONE: DAVIS Linda Humphrey MAILING ADDRESS: 100 Courthouse Square, Suite 2, Bloomfield, IA PHONE: DECATUR Sandy Higdon MAILING ADDRESS: 207 N. Main Street, Leon, IA PHONE: FAYETTE Lori Moellers MAILING ADDRESS: P.O. Box 267, West Union, IA, PHONE: FLOYD Gloria A. Carr MAILING ADDRESS: 101 S. Main Street #302, Charles City, IA, PHONE: HAMILTON Kim Schaa MAILING ADDRESS: 2300 Superior Street, Suite 2, Webster City, IA PHONE: HANCOCK Debra Bellinghausen MAILING ADDRESS: P.O. Box 70; Garner IA PHONE: DELAWARE Carla Becker MAILING ADDRESS: 301 E Main Street, Room 210, Manchester, IA PHONE: FRANKLIN Michelle Giddings MAILING ADDRESS: PO Box 26, Hampton, IA, PHONE: HARDIN Renee McClellan MAILING ADDRESS: 1215 Edgington Ave., Suite 1, Eldora, IA, PHONE:

5 HARRISON Susan Bonham MAILING ADDRESS: 111 N. 2ND Avenue, Logan, IA PHONE: JASPER COUNTY Dennis Parrott MAILING ADDRESS: P.O. Box 944; Newton IA PHONE: LINN COUNTY Joel Miller MAILING ADDRESS: P.O. Box 1328, Cedar Rapids IA PHONE: HENRY Shelly Barber MAILING ADDRESS: 100 E. Washington St., Suite 202, Mt. Pleasant, IA PHONE: HOWARD Julie Chapman MAILING ADDRESS: 137 North Elm Street, Cresco IA, PHONE: HUMBOLDT Peggy Roce MAILING ADDRESS: P.O. Box 100 Dakota City, IA, PHONE: IDA COUNTY Lorna Steenbock MAILING ADDRESS: 401 Moorehead Street, Ida Grove, IA PHONE: IOWA COUNTY Kristen Miller MAILING ADDRESS: 970 Court Ave. Marengo, IA PHONE: JACKSON COUNTY Joell Deppe MAILING ADDRESS: 201 West Platt Street, Maquoketa, IA PHONE: JEFFERSON COUNTY Scott Reneker MAILING ADDRESS: 51 E. Briggs, Fairfield, IA PHONE: JOHNSON COUNTY Tom Slockett MAILING ADDRESS: 913 S. Dubuque St., Ste. 101, Iowa City, IA PHONE: JONES COUNTY Janine Sulzner MAILING ADDRESS: P.O. Box 109; Anamosa IA PHONE: KEOKUK COUNTY Christy Bates MAILING ADDRESS: 101 S. Main, Sigourney, IA PHONE: KOSSUTH COUNTY Amber Garman MAILING ADDRESS: 114 W. State Street, Algona, IA PHONE: LEE COUNTY Anne Pedersen MAILING ADDRESS: County Office Bldg., PO Box 190, Fort Madison, IA PHONE: LOUISA COUNTY Sylvia Belzer MAILING ADDRESS: P.O. Box 186; Wapello IA PHONE: LUCAS COUNTY Julie Masters MAILING ADDRESS: 916 Braden Avenue, Chariton, IA PHONE: LYON COUNTY Wayne Grooters MAILING ADDRESS: 206 S. 2nd Avenue, Rock Rapids, IA PHONE: MADISON COUNTY Joan Welch MAILING ADDRESS: P.O. Box 152; Winterset IA PHONE: MAHASKA COUNTY Kay Swanson MAILING ADDRESS: 106 S. 1st Street, Oskaloosa, IA PHONE: MARION COUNTY Jake Grandia MAILING ADDRESS: 214 E. Main, Knoxville, IA PHONE:

6 MARSHALL COUNTY Dawn Williams MAILING ADDRESS: 1 E. Main Street, Marshalltown, IA PHONE: O BRIEN COUNTY Barbara Rohwer MAILING ADDRESS: P.O. Box 380; Primghar IA PHONE: POTTAWATTAMIE COUNTY Marilyn Jo Drake MAILING ADDRESS: 227 S. 6th Street, Box 649, Council Bluffs, IA PHONE: MILLS COUNTY Carol Robertson MAILING ADDRESS: 418 Sharp Street, Glenwood, IA PHONE: OSCEOLA COUNTY Barbara Echter MAILING ADDRESS: 300 7th Street, Sibley, IA PHONE: POWESHIEK COUNTY Dianna Dawley MAILING ADDRESS: PO Box 57, Montezuma, IA PHONE: MITCHELL COUNTY Lowell Tesch MAILING ADDRESS: 508 State Street, Osage, IA PHONE: PAGE COUNTY Melissa Wellhausen MAILING ADDRESS: 112 E. Main, Clarinda, IA PHONE: RINGGOLD COUNTY Laurie Greenman MAILING ADDRESS: 109 W. Madison, Mount Ayr, IA PHONE: MONONA COUNTY Brooke A. Kuhlmann MAILING ADDRESS: 610 Iowa Avenue, Onawa, IA PHONE: PALO ALTO COUNTY Carmen Moser MAILING ADDRESS: PO Box 95, Emmetsburg, IA PHONE: SAC COUNTY Jim Dowling MAILING ADDRESS: 100 NW State St Box 1, Sac City, IA PHONE: MONROE COUNTY Jeannie Bettis MAILING ADDRESS: 10 Benton Avenue E, Albia, IA PHONE: PLYMOUTH COUNTY Stacey Feldman MAILING ADDRESS: 215 4th Avenue SE, Le Mars, IA PHONE: SCOTT COUNTY Roxanna Moritz MAILING ADDRESS: 600 W 4th St, Davenport, IA PHONE: MONTGOMERY COUNTY Ted Schoonover MAILING ADDRESS: PO Box 469, Red Oak, IA PHONE: POCAHONTAS COUNTY Margene Bunda MAILING ADDRESS: 99 Court Square, Pocahontas, IA PHONE: SHELBY COUNTY Marsha Carter MAILING ADDRESS: 612 Court Street, Harlan, IA PHONE: MUSCATINE COUNTY Leslie Soule MAILING ADDRESS: 414 E. 3rd Street, Muscatine, IA PHONE: POLK COUNTY Jamie Fitzgerald MAILING ADDRESS: 120 2nd Avenue, Des Moines, IA PHONE: SIOUX COUNTY Lois Huitink MAILING ADDRESS: PO Box 18, Orange City, IA PHONE:

7 STORY COUNTY Lucy Martin MAILING ADDRESS: 900 6th Street, Nevada, IA PHONE: WASHINGTON COUNTY Daniel Widmer MAILING ADDRESS: PO Box 889, Washington, IA PHONE: WRIGHT COUNTY Betty Ellis MAILING ADDRESS: 115 N. Main, PO Box 147, Clarion, IA PHONE: TAMA COUNTY Laura Kopsa MAILING ADDRESS: PO Box 61, Toledo, IA PHONE: WAYNE COUNTY Sue Ruble MAILING ADDRESS: PO Box 435, Corydon, IA PHONE: TAYLOR COUNTY Bonny Baker MAILING ADDRESS: 405 Jefferson, Bedford, IA PHONE: WEBSTER COUNTY Carol Messerly MAILING ADDRESS: 703 Central, Fort Dodge, IA PHONE: UNION COUNTY Sandy Hysell MAILING ADDRESS: 300 N. Pine St., Ste. 2, Creston, IA PHONE: WINNEBAGO COUNTY Karla Niederkofler MAILING ADDRESS: 126 S. Clark Street, Forest City, IA PHONE: VAN BUREN COUNTY Jon Finney MAILING ADDRESS: PO Box 475, Keosauqua, IA PHONE: WINNESHIEK COUNTY Benjamin D. Steines MAILING ADDRESS: 201 W. Main Street, Decorah, IA PHONE: WAPELLO COUNTY Kelly Spurgeon MAILING ADDRESS: 101 W. 4th, Ottumwa, IA PHONE: WOODBURY COUNTY Patrick Gill MAILING ADDRESS: 620 Douglas St., Room 103, Sioux City, IA PHONE: WARREN COUNTY Traci Vanderlinden MAILING ADDRESS: 301 N. Buxton, Ste. 101, Indianola, IA PHONE: WORTH COUNTY Kay Clark MAILING ADDRESS: 1000 Central Avenue, Northwood, IA PHONE: PAID FOR BY OBAMA FOR AMERICA PRINTED BY VOLUNTEERS 7