Rescribed by the s ecretary of the




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Prescribed by the Secretary of the State

- (G:\forms\ED-600's\ED642.sam (Español en otro Lado)




Confirmation of Voting Residence

ED-642 (2/96)



From: REGISTRARS OF VOTERS

Town of


DISTRICT NUMBER

LAST DATE to Return Confirmation of Voting Residence



We believe you no longer live at the address shown below.

‰ If you did not change your residence, or Changed your residence to a new address



within this town,

  1. Please fill out Part C & mail it in enclosed envelope, or deliver it to us by date above

  1. If Part C is not returned:

  1. Affirmation or confirmation of your address may be required before you can vote,
    AND

  2. In four years, your name will be removed from the voter list, if you do not vote in an
    election or primary or do not restore your voting rights.

ˆ If you have changed your residence to a different town:


† You must register to vote in your new town.


  1. If you need a Mail-in Voter Registration Card, let us know.

  1. Please fill out Part C & mail it in enclosed envelope, or deliver it to us by date above


Don't RISK Your Right to VOTE!

Fill out & Return Part C!!


Name and


Address on

Last List of Registered

Voters












Birth Date_________________________






Registrars of Voters (names, addresses, phone numbers)

Any questions, call us

DATE NOTICE SENT






(Español en otro Lado)







Confirmation of Voting Residence

ED-642 (2/96)



From: REGISTRARS OF VOTERS

Town of


DISTRICT NUMBER

LAST DATE to Return Confirmation of Voting Residence







We believe you no longer live at the address shown below.

‰ If you did not change your residence, or Changed your residence to a new address



within this town,

  1. Please fill out Part C & mail it in enclosed envelope, or deliver it to us by date above

  1. If Part C is not returned:

  1. Affirmation or confirmation of your address may be required before you can vote,
    AND

  2. In four years, your name will be removed from the voter list, if you do not vote in an
    election or primary or do not restore your voting rights.

ˆ If you have changed your residence to a different town:


† You must register to vote in your new town.


  1. If you need a Mail-in Voter Registration Card, let us know.

  1. Please fill out Part C & mail it in enclosed envelope, or deliver it to us by date above






Name and


Address on

Last List of Registered

Voters








Birth Date_________________________






Registrars of Voters (names, addresses, phone numbers)

Any questions, call us

DATE NOTICE SENT

(Español en otro Lado)




Confirmation of Voting Residence

RETURN FORM Part C

To: REGISTRARS OF VOTERS

Town of


DISTRICT NUMBER

LAST DATE to Return Confirmation

of Voting Residence






Please check () all appropriate boxes and enter information requested.

1. I still live at the address shown on this card.

3. I have moved to a different address within this town.

4. I have moved out of town. 5.Send a Mail-in Card to register in my new town



(Return Before Date Entered Above)

2.Temporarily absent from town, but I intend to return. (Reason for your absence)

_____________________________________________________________________





MY NEW ADDRESS IS (No., street, town, state)

DATE MOVED

_________________________________________________________________________________________






























Name and Address on Last List of Registered Voters






Birth Date:____________________________
















SIGNATURE OF VOTER

DATE SIGNED
















Don't RISK Your Right to Vote - Return this to Registrars




ED-642 (2/96)




























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