CHAPTER I: STATE BOARD OF ELECTIONS
PART 216 REGISTRATION OF VOTERS
SECTION 216.EXHIBIT H ADDRESS CORRECTION FOR FAIL SAFE VOTER
Section 216.EXHIBIT H Address Correction for Fail Safe Voter
Mandated
December, 1995
SBE No. C-6
ADDRESS CORRECTION FOR FAIL-SAFE VOTER
□ FEDERAL BALLOT ONLY
ˇ Voters who change residence to another address within Election Authority's jurisdiction.
ˇ Voting in former residence polling place or when applying for absentee ballot.
Social Security Number (last four numbers: ______________________________
Date of Birth: ________________________
Voter's Full Name (Please Print):
__________________________________________________________________
Current Address:
__________________________________________________________________
City/Village ___________________________ Zip Code _________________
Former Address:
__________________________________________________________________
City/Village ___________________________ Zip Code _________________
__________________ _____________________________
Date Signature of Voter or Mark