Dear Town/City Clerk:
My name is [enter name]. and I am registered to vote in [Town/city]. I am planning to vote in person during the upcoming election on November 2nd, 2021. However, due to my disability, I am unable to vote privately and independently.
Because I am [blind or have low vision], it is impossible for me to complete a paper ballot independently. I am writing you to request that [enter town/city name] provide an accessible voting device for the upcoming election so that I can complete my ballot privately and independently. An accessible voting device could be similar to the One4All accessible voting system that is already used during state and federal elections.
[Town/city] is obligated to provide me with this accommodation. The Americans with Disabilities Act and Section 504 of the Rehabilitation Act require local governments to provide people with disabilities equal access to government services and programs, which includes voting. Voters without vision impairments are entitled to fill out their ballots privately and independently. However, blind and vision impaired voters are unable to complete a ballot privately and independently without an accommodation. [Town/city] must provide an accommodation for blind and visually impaired citizens to vote privately and independently in local elections. Failure to do so is a violation of federal law.
I am hopeful that I will be able to vote using an accessible voting device in the upcoming election. Please let me know by October 22, 2021, if [Town/city] will be able to provide me with an accommodation. Also, please feel free to contact me any time if you have further questions. You can also contact Future In Sight at futureinsight.org for assistance in implementing an accessible voting system.
I look forward to hearing back from you soon.