SBE 01 (08/03)
You MUST answer questions A & B below before completing this form.
NO If you checked “no” in response to either of
NO these questions, do not complete this form.
A. Are you a citizen of the United States of America?
B. Will you be 18 years of age on or before election day?
FOR CLERK USE ONLY
Social Security Number
Date of Birth (M-D-Y)
County (where you live)
Suffix (circle one)
Jr. Sr. II III IV
Address where you live (do not give PO Box address):
Address where you get your mail
(if different from above):
Party Registration – check one box
(write name above)
If you select “Other” as your party affiliation, you are
eligible to vote for only nonp