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Please send me a mail/absentee ballot for (check one): 2014 Primary August 26, 2014 2014 General November 4, 2014, All elections for which I am eligible through 2016 Last Name First Name / / Date
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Please complete if making is a form that needs to be filled out when submitting a specific request or application.
Any individual or entity who is making a request or application that requires the completion of this form.
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