New York State Voter Registration Form (See instructions on page 1) @ sicscinatosrceve stele egeton era tureh tte nrmatonto te Boer! Gectons. _Paeeriindo erlcknk Areyouscitzenattheus? fives One T yew Na, youcant eee @ aualifications Wit yout eyes ofa or 2 _shetonerbdoreclectondey? (ves (No ypu saree Nl youcanotagir tote ress youvlbe By tsstname (ARAL Feotname Ant Your name ‘More information 4 snare [pF O6U, 4.61 ¢ se gy OF Gi) _Teeononeorior| , , H], . .. | Addrssnaro bod 629 Evry Zoiawd Tendon yams roo where you live tyrTown/ i en ‘Address FP. Box you receive mail ® Voting history @ Heyouvotedbetore? _filves CN We) _Wintyeor (20,77) Voting information Yosroanawa that has changed 11 _Youraddress was Sienna ersder Padang Your eos ator Nw ek tat County we identiteation Thaw eS Dae ovmareataecon ag taerdotctey Sood Seartynmier xe x2 x Sohlas 5.0) eee TE eset Ne eS ean Sosy eb Poca party a @ Attidavit: swear or tim that ‘conus aeton Dr Penenpory corms es 7 1 Ving ats Seer Di intperdowenaty Gagamecens” Ol Genny » see ee ie eesioen 1D Loortwientoanatinapany / Cingiwome SOM Optional questions 4g =" soni flix epost (7-t Soest om MeL eV _|