A Year Of Age On Or Before Election Day?

Submitted By oyousobad
Words: 620
Pages: 3
Open Document
NORTH CAROLINA VOTER REGISTRATION APPLICATION
Please use black or blue ink and print legibly.

1

Are you a citizen of the United States of America?

Yes

06w

Date Received

No Will you be at least 18 years of age on or before election day?

IF YOU CHECKED "NO" IN RESPONSE TO THIS QUESTION,
DO NOT SUBMIT THIS FORM.

2

FOR OFFICE USE ONLY

No

Are you at least 16 years of age and understand that you must
Yes
No be 18 years of age on or before election day to vote?
IF YOU CHECKED "NO" IN RESPONSE TO BOTH OF THESE QUESTIONS
ABOVE, DO NOT SUBMIT THIS FORM.

Last Name (Required)

First Name (Required)
M
M
D
D

Y

Y

Middle Name (Required)

Y

Y

Sr

II

III

County of Birth

Jr

Date of Birth MMDDYYYY (Required)

If you know your NC Voter Registration Number, please enter it here:

3

Yes

IV

V

State of Birth

Do you have a NC Driver's License or DMV-issued identification card? If yes, provide the number.

Yes

No

If you do not have a NC DMV-issued license or ID card, do you have a Social Security Number? If yes, provide the last 4 digits.

Yes

No

XXX

-

XX

-

RESIDENTIAL ADDRESS INFORMATION (STREET ADDRESS WHERE YOU LIVE) - No P.O. Boxes or Rural Routes

4

Street Address where you live (Required)

Apartment, Lot, or Unit Number

NC
City (Required)

State

Have you lived here for 30 days or more?

County

Yes

Zip Code

No
If "No," date moved? MMDDYYYY

Phone (Optional)

MAP/DIAGRAM

MAILING ADDRESS

If you do not have a street address, draw a map of where you reside.
Please include roads and landmarks.

5

Mailing Address (If different from your residential address)

State

City

6

GENDER

RACE

Zip Code

POLITICAL PARTY AFFILIATION

ETHNICITY

Female

African American/
Black

American Indian/
Alaska Native

Male

Asian

Multiracial

White

Other

Hispanic/Latino

Democrat

Republican

Not Hispanic/
Latino

Unaffiliated

Other

Libertarian

If you indicate a political party that is not currently qualified or you do not indicate a choice, you will be listed as "Unaffiliated."

PREVIOUS REGISTRATION (Name & Address used for your last voter registration - If applicable)

7

Last Name used in Previous Registration

First Name

Previous Address

State

Previous City
Show More

Related Documents: A Year Of Age On Or Before Election Day?

The Laws Of St. Laurent

rebellion described in the history of the Northwest Rebellion. 1874 In 1874, a few traders who traded the natives cheap alchohol for fur and buffalo robes, attacked and killed nearly 30 natives. Because of these traders the natives that actually traded with these men developed alchoholism and this lead to, alchoholism, mal-nourishment, and alchohol related diseases. The government then hired the Canadian Mounted Police to patrol the areas of trade in the Northwest to prevent the ongoing problems…

Words 751 - Pages 4

Summary: Brain On Fire

rare disease that not many people know about. She went to many different doctors and no one knew what was going on with her. The doctors mislabeled her illness because her disease was rare and the disease caused her to go through different symptoms. The disease she has is anti-NMDA-receptor autoimmune encephalitis, since she was going through different symptoms the doctors weren’t able to diagnose her with a correct mental illness. Most people who have it weren’t aware they have a disease called…

Words 1240 - Pages 5

hi i am sabrina Essay

prevent the abandonment of infants and young children by providing needed resources through model programs. This program also funds technical assistance, including training, with respect to the planning, development and operation of the projects. Alchohol, Tabaccoo, and Firearms Training Assitance: $1,900,000 total funding Percent:.6% percent Purpose of this program:To help the participant identify the laws relating to alcohol, tobacco, firearms and explosives, and provide training in specific…

Words 675 - Pages 3

The Cambodian Genocide: Pol Pot

create a socially engineered society. Khmer Rouge had policies such as torture, mass executions, forced relocation and labor. A total of up to two million Cambodians would eventually be die over the course of four years with execution, starvation, disease and overwork being the main contributors. No one was safe as something as simple as wearing glasses or knowing a foreign language could be killed. Even those with little education were tortured and executed in special centers. One of the most famous…

Words 933 - Pages 4

Essay about Levelo 5 Unit 33 Question 1

Dementia Dementia syndrome is the term used for the progressive disease of the brain that leads to the deterioration in the individuals mental functions. It can be as a result of a stroke, Alzeimers and even Parkinsons, some brain tumours, or even an infection to the brain cells. It could also be as a result of a simple fall, a deficiency in their daily diet, or a thyroid deficiency, a much less common known cause is also alchohol abuse. The brain is made up of millions of cells and it is known…

Words 2376 - Pages 10

Essay on An ayurvedic case study

specially buttermilk, cheese, cottage cheese, ghee, milk and yogurt. -Meat and Fish: Small amounts: chicken or turckey , salt water fish. NOTE* - Repeated research show that plant based diets are healthier than meat based diets and prevent many diseases. -Patient has a strong interest on detoxifying, recommended: Hot spices like: cayenne, black pepper, dry ginger, long pepper, asafoetida, mustard, cardammon, cumin, coriander, basil, fennel. Food combination should be kept simple with only a…

Words 1707 - Pages 7