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C0/04/2007 15 : 19 FAN 917 723 1372 SEC. OF COMMONWEALTH 003/003 <br /> v" v.r 'Vv r a•au J.9! 'a rAn e1f4519524 C A B 4004/004 <br /> To register to vote In musachusetb you must ba; <br /> - a U.S.CMZHNI end <br /> - a Nlat3achu0etti reeiden0 and <br /> - .at least 18 years of age or olderon or before me nasi election, <br /> Pa you want to register to vote? l�Yes O No ®Check■1r that apply: <br /> • Ch6ck'Yea'H you went to register to Vote,or you are changing your name <br /> or addreas end want to be registered to vote with this now i damndoa• Are You a citizen of du United Statas at Ams..l �a O No <br /> • Check No'Hyou amourranlly registered to vote and do not want to change <br /> your voter reglsme bon or do not want to no to vote. Will you be at least 18 years of age or older on or before need siactfon <br /> It yvu anahwersd-yVS,-complete quasuon M2 and read me Aigmlation Saegbn "a ❑No <br /> below. NOTE: If you answered•rb'to eiuer of these questions.do not complete <br /> quesJOn a3. You are ibt eligible to register to vote at this time. <br /> Eff Floats indicate party entailment or poiigcal designation(check ens). <br /> Q Oamoerat ❑Repubaean�No Party(unenrolled) O Pollfl al Deslgnetlon(nota poif icalparty): <br /> PLEASE ASK THE LICENSE CLERK POR YOUR VOTER RE0I5TRA77ON RECEIPT (P+aa d"red deslgnabon.) <br /> When you aign your name at the apuntor to complete this tranmucllon,you will be swearing(afrmning)that you are the Denson itlen;W m this tom:mat the <br /> ahloematkn on Itds krrri is We;T}tATYOUARE A CITIZEN O/THE UNITED STATES;ghat you ere not a person utedera guhpdianship whlrlh pmhlhlte you hyrp <br /> registering to vote,mal you are rid IenhgprArdy,Dr Dermenehtf dittivaaaad by Lew from voting baoetpe of mrrupl pnarrpsa wish mapact b ereoaono;and dial <br /> yds consider the residential address recited on dots form to be your tome address. <br /> Confidentiality df vorar ragiNagon information: <br /> If you register Id vote,the office at whish you submg your application will remaln cdn8dentfal and will be used only for voter mglaUodon purposes. <br /> If you decline 10 rcglater to vole,the fact Itut you declined to register will remain confidential and will be used only for voter mgisfratfon purposes. <br /> Penalty for Iflegal voter ragfstraffoa; Fine Of not more than 410,000 ar imprisonment far not mare man 006 yaen or tach(IvLQL.,C map.be,Section p). <br /> T <br /> b � <br /> ,'Elie{�eglatrar rosgyes toe E1da. ncel _Us 0e'no�and raeal{fh '0o�orajNo7,oe�.Msaraefiopam•Iswiequ4o <br /> Y•penid_t;;;ncod�ey!of"'Ir)r7, �taPt>c`trk Heoajmias;tha4ine!= o apprhoattl W_84'�k A d h� d ,suC�pdraul,teca{eserrar+b s;Vy7 + hx`a_:. t f�oTfehn <br /> .6 its, <br /> FaitnfTg6n''al ,1 I"U;EY"G"AoA <br /> fJ�rt,meNts u <br /> r. •++hrtaalPMr.€iivtcp,em"�batowphemgrh�i/r� t '- )� { - �h h M 1 .1 tr. ( , <br /> enastasaoidd,bare^aaa/aurrelRa�as.'�w.�`p!appam� anad+.rriw by �t yvt.�..wsi�wr u „ ,. <br /> 3 �c"r'y�,qp{ ,,ty hof n�adw+panvrt <br /> air& tiF •.C.." ,,,FI.S it ;`r$• Ltt°i+brTl`yWylebadd".bo„ Iia ^ire , <br /> ;r! <br />