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Get You Can Use This Form To Register To Vote Report That Your Name Or Address Has Changed Register

Ote report that your name or address has changed register with a party This space for office use only. Please print in blue or black ink 1 2 Mr. Mrs. Miss Ms. First Name Last Name Middle Name(s) (Circle one) Jr Sr II III IV Address (see instructions) Street (or route and box number) Apt. or Lot # City/Town State Zip Code Address Where You Get Your Mail If Different From Above (see instructions) City/Town State Zip Code 3 4 7 Date of Birth Month Day 5 Year Telephone Numb.

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