Fill and Sign the Keeping Voters off the Rolls Center for American Progress Form

Form D – Rev. 02/201 8 Page 20 FATHER SURVEY SHEET ON VOTER REGISTRATION FOR AMERICAN CITIZENS ONLY (CHECK ONLY ONE OF THESE) I am not a registered voter and I am NOT interested in registering under my new n ame at this time. STOP. DO NOT FILL OUT OR SIGN THIS FORM. I am NOT a registered voter, but would like to register to vote under my new name. I am a registered voter and would like my name changed on the voter registration list PLEASE COMPLETE THIS FORM, SIGN IT AND RETURN WITH YOUR NAME CHNAGE FO RMS. I am a registered voter and would like my name and address chan ged on the voter registration list. PLEASE COMPLETE THIS FORM, SIGN IT AND RETURN WITH YOUR NAME CHANGE FORM. When you have your name changed legally, you need to change y our voter registration as well. Please fill out the information below and return this form with your name change Petition. When your na me change order is signed by the Lieutenant Governor, your voter registration will automatical ly update to reflect your new name. 1. I am registered to vote on _________________________ (Island) 2. My name is being changed from ______________________________________ to ______________________________________________________________ 3. My residence address is _____________________________________________ 4. My telephone number is (H) (B) ____________________ 5. My mailing address is _______________________________________________ 6. My social security number is __________________________________________ 7. My date of birth is __________________________________________________ Signed, ___________________________________ (New Name) ******************************************************************************* (FOR OFFICE U SE ONLY) Name Change Effective on: ___________________ Date granted by Lt. Gov: _________________ Form D – Rev. 02/201 8 Page 21 MOTHER SURVEY SHEET ON VOTER REGISTRATION FOR AMERICAN CITIZENS ONLY (CHECK ONLY ONE OF THESE) I am not a registered voter and I am NOT interested in registering under my new n ame at this time. STOP. DO NOT FILL OUT OR SIGN THIS FORM. I am NOT a registered voter, but would like to register to vote under my new name. I am a registered voter and would like my name changed on the voter registration list PLEASE COMPLETE THIS FORM, SIGN IT AND RETURN WITH YOUR NAME CHNAGE FORMS. I am a registered voter and would like my name and address changed on t he voter registration list. PLEASE COMPLETE THIS FORM, SIGN IT AND RETURN WITH YOUR NAME CHANGE FORM. When you have your name changed legally, you need to change your voter registration as well. P lease fill out the information below and return this form with your name change Petition. When your na me change order is signed by the Lieutenant Governor, your voter registration will automatical ly update to reflect your new name. 1. I am registered to vote on _________________________ (Island) 2. My name is being changed from ______________________________________ to __________________________________ 3. My residence address is _____________________________________________ 4. My telephone number is (H) (B) ____________________ 5. My mailing address is _______________________________________________ 6. My social security number is _________________________________________ 7. My date of birth is __________________________________________________ Signed, ___________________________________ (New Name) ******************************************************************************* (FOR OFFICE USE ONLY) Name Change Effective on: ___________________ Date granted by Lt. Gov: _________________