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Ame (Please print) Middle or Maiden Name First Name If you have moved since registering to vote, please update your voter registration record with the county board of registrars before proceeding with this application. Street Address (address where you are registered to vote; do not use PO box) ZIP City Mail my ballot to the address where I regularly receive mail, if different from the street address provided above. Precinct where you vote (name and/or location of your polling place) Date.

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