Maine Voter Registration FormMaine Voter Registration Form
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MAINE VOTER REGISTRATION APPLICATION

PARTY AFFILIATION
This portion must be completed.
‰ Democratic
Federally required questions:
‰ Green Independent

Are you a citizen of the United States of America?
‰ YES ‰ NO
‰ Republican

Will you be 18 years of age on or before Election Day? ‰ YES ‰ NO
‰ Other _________________
‰ I do not wish to enroll in a
(If you checked “no” in response to either of these questions, do not
political party at this time
complete this form.)
(designated as “Unenrolled”)
LAST NAME

FIRST NAME

MIDDLE NAME

DATE OF BIRTH

_ _/ _ _ / _ _ _ _
MM

D D

Y Y Y Y

STREET OR LOCATION ADDRESS (Where you live)
(STREET NAME AND NUMBER, NOT A P.O. BOX)
CITY, TOWN, PLANTATION OR TOWNSHIP

CURRENT MAILING ADDRESS (If different from address above)
NUMBER AND STREET OR P.O. BOX, etc.
CITY/TOWN

ZIP CODE

PREVIOUS REGISTRATION ADDRESS (Complete or write “none” below)
CITY/TOWN
COUNTY
STATE
ZIP CODE

TELEPHONE
(Optional)

COMPLETE BOTH SIDES OF THIS CARD – PLEASE PRINT

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