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Address Change Form





  • Date of Birth: *

  • Last Four Numbers of your Social (to identify your voter's registration): *

  • New Address:



  • Former Address:



  • List anyone else in your household:


  • Please provide the Name, DOB, & Last Four of Socials for each household member.

  • Household Members:

  • Other Information:


  • Please fill out the fields below if applicable.

  • ACCT#:

  • Map:

  • District:

  • Parcel:

  • Deputy Making Changes:

  • Additional Information:

  • Please Select Box Below: *



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