Solicitud de Voto Por Correo permanente

APPLICATION FOR PERMANENT VOTE BY MAIL STATUS
Dear Registrar-Recorder/County Clerk:
I am currently a registered voter in Los Angeles County and am applying for Permanent Vote By Mail status.
NAME: (PRINT) _________________________________________________________________________
DATE OF BIRTH:_________________________________________________________________________
REGISTERED ADDRESS: __________________________________________________________________
CITY: ______________________________________________________ ZIP CODE:___________________
SIGNATURE AS REGISTERED �____________________________________________________________
DATE: ______________________
TELEPHONE NUMBER: (
)____________________
Address where ballot will be mailed (if different from registered address)
ADDRESS: (PRINT) _____________________________________________________________________
CITY: ____________________________________________________ ZIP CODE: ___________________
OFFICE USE ONLY
INPUT DATE
INTL
NOTIFICATION DATE
INTL
VID #
Registrar-Recorder/County Clerk 12400 Imperial Hwy., Norwalk, Ca 90650 USA Rev. 1/08
Por favor utilice la solicitud de muestra a continuación como una guía para completar la Solicitud de Voto por Correo Permanente.
Muestra. Por favor complete la anterior solicitud en Inglés para solicitar la Condición de Voto por Correo Permanente.
APPLICATION
PERMANENT
BY MAIL
STATUS
SOLICITUD PARAFOR
CONDICIÓN
DE VOTOVOTE
POR CORREO
PERMANENTE
Estimado
Oficial del Registro Civil/Secretario
Dear Registrar-Recorder/County
Clerk: del Condado:
I am currently
registered
voter in en
Los
County
and am
applying
for Permanent
By Mail
status.
Actualmente
soyaun
votante registrado
el Angeles
Condado de
Los Angeles
y solicito
la condición
de VotoVote
Por Correo
Permanente.
NOMBRE:
DE MOLDE) __________________________________________________________________________
NAME: (LETRA
(PRINT)___________________________________________________________________________
DATE DE
OFNACIMIENTO:
BIRTH:___________________________________________________________________________
FECHA
_______________________________________________________________________________
REGISTERED
ADDRESS:____________________________________________________________________
DOMICILIO
REGISTRADO:
_____________________________________________________________________________
CITY:______________________________________________________ZIPCODE:______________________
CIUDAD: _____________________________________________________ CÓDIGO POSTAL: _______________________
SIGNATURE
AS REGISTERED�______________________________________________________________
FIRMA
(COMO ESTÉ
REGISTRADO) X ____________________________________________________________________
DATE: ______________________
FECHA:
TELEPHONE
NÚMERO DENUMBER:
TELÉFONO: ((
))____________________
______________________
Address donde
where debe
ballotenviarse
will be mailed
(if(si
different
from al
registered
Domicilio
la boleta
es diferente
domicilioaddress)
registrado)
DOMICILIO:
DE MOLDE) ________________________________________________________________________
ADDRESS:(LETRA
(PRINT)_________________________________________________________________________
CIUDAD:
_____________________________________________________ CÓDIGO
POSTAL:______________________
______________________
CITY: ____________________________________________________
ZIP CODE:
PARA
USOUSE
OFICIAL
EXCLUSIVO
OFFICE
ONLY
INPUT DATE
INTL
NOTIFICATION DATE
INTL
VID #
Registrar-Recorder/County Clerk 12400 Imperial Hwy., Norwalk, Ca 90650 USA
Rev. 1/08
SPANISH