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Or before election day? IF YOU CHECKED "NO" IN RESPONSE TO THIS QUESTION, DO NOT SUBMIT THIS FORM. 2 Yes No IF YOU CHECKED "NO" IN RESPONSE TO THIS QUESTION, DO NOT SUBMIT THIS FORM. Last Name (Required) Date of Birth MMDDYYYY (Required) 3 State of Birth/Country of Birth First Name (Required) If you know your NC Voter Registration Number, enter it below. Middle Name (Required) If you have a NC drivers license or non-operators ID card, enter the number below. Jr Sr III IV Enter.

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