2. Name of Owner of Property or Registered Voter
4. First Name
5. Last Name
7. Legal Description of Property (or deed) or General Area for Voter Registration
9. Parcel Number, Lot Number and Subdivision, or General Area
11. City
12. Zip Code
14. Years of Registration or Residence Requested
16. Which years, between 1952 and 1964, were residence or registration effective?
18. Contact Information
20. Email
21. Phone Number
23. First Name
24. Last Name
26. Address1
28. Address2
30. City
31. State
32. Zip
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34. 1. Receive an email copy of this form.
35. Email address

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36. Submit

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