Agenda Packet 9-24-18 Meeting - Laserfiche WebLink

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x x x - x x - 1 qualifications If you mark no in response to either of these questions, do not complete this form. Are you a citizen of the United States of America? yes no Will you be 18 years of age on or before election day? yes no 2 personal information *denotes optional information name last first middle Oregon residence address (include apt. or space number) city zip code date of birth (month/day/year) county of residence* phone number* email address* mailing address (required if different than residence address) city zip code 3 political party choose one of the following: Constitution Party Democratic Party Independent Party Libertarian Party Pacific Green Party Republican Party Working Familes Party Not a member of a party Other 4 Oregon DMV Driver's License/ID number If you fill in this section, do not send a copy of ID. valid Oregon DMV Driver's License/ID number Mark here only if you do not have a valid Oregon DMV Driver's License/ID and go to step 4a. 4a last four digits of Social Security number If you fill in this section, do not send a copy of ID. last four digits of Social Security number Mark here only if you do not have a valid Oregon DMV Driver's License/ID or a Social Security number. If you are registering by mail, please include a copy of acceptable identification, listed to the left. 5 signature I swear or affirm that I am qualified to be an elector and I have told the truth on this registration. sign here date today If you sign this card and know it to be false, you can be fined up to $125,000 and/or jailed for up to 5 years. 6 registration updates If you are previously registered and updating your information, fill out this section. previous registration name previous county and state home address on previous registration date of birth (month/day/year) September 24, 2018, Meeting - Item 3