Mississippi Secretary of State

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Stop Voter Fraud

If you would like to report voter fraud, please fill in each blank of the form. After you have filled in all of the required information (denoted by * ) and clicked on the button, you will receive an e-mail confirming that your report has been received by the Secretary of State's Office.
Thank You.

Name:	First* Last*
Address:
City:	State Zip
Contact Number:	*
Alternate Number:
e-Mail:	*
Name of your polling place:
Date Incident Occurred:	*

	Please explain the circumstances surrounding your complaint. Please be VERY specific and include ALL relevant information. (2000 Characters Maximum)

	Are there other individuals we should talk to regarding these issues?
	No Yes
	If yes, please list the name, address, and phone number for up to two individuals.

Person 1:
Title:	First Last
Address:
City:	State Zip
Phone:

Person 2:
Title:	First Last
Address:
City:	State Zip
Phone:


	If the Attorney General's Office is able to prosecute this allegation of voter fraud:
	I wish to remain anonymous.
	I wish to remain anonymous, but will provide further information.
	I wish to cooperate with law enforcement and testify in all states.