REGISTERED VOTING NAME DATE ADDRESS ZIP CONGR. NAME |
---|
(Signature) | SIGNED | (Street) (City, | CODE | DIST. | (Printed |
Town or Village) | or Typed) | ||||
.......................... |
Signature of Affiant |
(Person obtaining signatures) |
.......................... |
Address of Affiant |
.......................... |
Signature of Notary |
REGISTERED VOTING NAME DATE ADDRESS ZIP CONGR. NAME |
---|
(Signature) | SIGNED | (Street) (City, | CODE | DIST. | (Printed |
Town or Village) | or Typed) | ||||
Signature of Affiant | |
(Person obtaining signatures) | |
Address of Affiant |
Signature of Notary |
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