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Get AU AEC ER005A 2017-2024

Iss Ms Other Family name Given name(s) Elector s enrolled address As shown on the electoral roll Elector s current postal address (if known) Leave blank if the same as enrolled address 2 Reason the elector should not be enrolled 3 Details of the person lodging the objection State Postcode State Postcode Of unsound mind and incapable of understanding the nature and significance of enrolment and voting Note: The medical certificate on the next page must be completed by a registered m.

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