§216.EXHIBIT F. Confirmation of Address

SIDE A (top) Second Notice (Bottom) Addressee Side-Reply Card   (6 x 8" duo-fold Postcards)

Suggested Revised, Jan. 1997 SBE No. R-26

CONFIRMATION OF ADDRESS   □     OUR RECORDS INDICATE THAT YOU HAVE MOVED TO ______________________________.   •      To confirm this information complete and return the postcard at the bottom, not later than              _________________________________________ .     •      This new address has been added to your voter registration record.  Your new precinct is ______.   □     WE HAVE NOT BEEN ABLE TO CONFIRM YOUR ADDRESS.     •      Please complete and return the postcard at the bottom, not later than _____________________.     •      If this card is not returned, you may be required to confirm your address before being permitted to vote in a Federal election.  If this card is not returned and you fail to vote during the period beginning on the date of this notice and ending on the date of the second general election that occurs after the date of the notice, your registration will be cancelled.   □      IF YOU HAVE MOVED TO AN ADDRESS OUTSIDE OF ________________________________

4 x 6

OUTGOING

POSTCARD

(jurisdiction)

•  You will have to register with the County Clerk or Board of Election Commissioners where you live.  (Consult your telephone directory.)

(tear here)

perforated

perforated

fold

fold

NO POSTAGE

NECESSARY

IF MAILED

BUSINESS REPLY MAIL

IN THE

FIRST CLASS MAIL PERMIT NO 0000 ANYTOWN, STATE

UNITED STATES

preprinted FIMC

POSTAGE WILL BE PAID BY ADDRESSEE

OFFICIAL ELECTION MATERIAL

4 x 6

PREPAID

REPLY

ELECTION OFFICIAL

ELECTION OFFICE

STREET ADDRESS OR PO BOX

CITY, ST 00000-0000

 

	Preprinted Address	Preprinted Bar Code
	With Zip + 4	Corresponding to Zip + 4

back of SBE No. R-26

Preprinted FIMB If Postage Paid

Without Bar Code

Preprinted Address

Preprinted FIMC If Postage Paid

and Bar Code is Applied

ELECTION OFFICIAL

ELECTION OFFICE

Method of

OUTGOING

STREET ADDRESS OR PO BOX

FIRST CLASS MAIL

Postage at

FIRST CLASS

CITY, ST 00000-0000

U.S. POSTAGE PAID

Discretion  of

POSTCARD

ANYTOWN, STATE

Election Authority

PERMIT NO. 0000

OFFICIAL ELECTION MATERIAL

Optional Line)

NON-ADDRESS DATA

(Top Line)

NAME OF RECIPIENT

(Optional Line)

INFORMATION/ATTENTION LINE

4 x 6

(Line Above Last)

DELIVERY ADDRESS

POST OFFICE (CITY) STATE ZIP CODE

Bar Code Area If automatically applied

perforated fold

PLEASE CHECK ONE

□  NEW ADDRESS

□  SAME ADDRESS

perforated fold

PRINT FULL NAME

(Include Middle Name)

DATE OF BIRTH

SOCIAL SECURITY NUMBER

4 x 6

(Last four numbers only)

REPLY

TELEPHONE NUMBER (Optional)

POSTCARD

MY ADDRESS IS

(Signature)

(Date)

*All of the above information is true.  I understand that if it is not true, I can be convicted of perjury and fined up to $5,000. and/or jailed 2 to 5 years.