Check home that apply:

1 [lg/New ragtst and Enrollment
Pa

rty Enrolment change

I need an appticauon for an Absmlea Baltot

Address Shanna
Name Change

 

 

 

 

 

 

 

The Board of Elections in the City of New York

 

I like to be an Etec Lian Bey Wanker
Are you a U. S. citizen?
IF ND, DO NOT COMPLETE THIE FORM

 

 

 

 

 

 

 

 

 

 

 

RUMP

 

 

 

 

 

 

 

 

L.

 

 

 

 

 

 

 

 

 

 

 

 

 

472: F-

 

 

 

 

 

 

 

 

 

 

 

 

Mdmas Where You Live [do nnl'gifa PD. admires:

 

 

 

 

 

 

LU


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5M1: Ft

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pddras: Where You Eat Your Itth

 

 

 

 

 

 

 

 

 

 

 

Beta/{LU}
mm

 

 

Data or arm [n we

 

9 C960

 

 

 

 

 

th Last Year You Vatnd Under the Name {It c?ttamnt Emmy-our name new]

 

7..

 

 

Hume Tetepttona-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Your Andrus We: {give house nun-bar, street and cit?)
Choose a party - Check on: be: only

 
   
 
 
  
 

10 Rapuhlinan Party
rnoerntie Party

Conservative Party
Liberal Party
[3 atom To Lita Party
Green Party

Print by: ysalman Printed on:

I meat-er af?rm that;

tam a, {amen of the Unrlad States.

Mi! have lived In the county. city. or

an day: berm erection
re urman: tn the but: below

This Is 

Independence Pan}! Mar to were it a

 

you

  

Working Families Party
Ida not wish to euro" In a party

  

rill-4?11

8/21/2015 2:52:39 PM ScanDate: 2001 08 10, BatchNumber: 29, DocumentNumber: 9

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gone and Number [Optlo

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

matron is true. I understand
ft is net tma lean be convicted met
:1an up to $5.001] enda'orja?ad for up to tour

EEan