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About how to ll out this application, please call your local voter registrar. 1 These Questions Must Be Completed Before Proceeding Check one New Application Change of Address, Name, or Other Information Request for a Replacement Card Are you a United States Citizen? Yes No Will you be 18 years of age on or before election day? Yes No If you checked 'No' in response to either of the above, do not complete this form. Are you interested in serving as an election worker? 2 Last Name.
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