Transcription of VR-154 (05-17)
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VR-154 (05-17)
Section A - All ApplicantsSection B - Voter RegistrationVR-154 (05-17)Certification: I hereby certify, under penalty of perjury, that the statements made on this form are true and correct to the best of my knowledge, information, and Signature Date:(required):Check boxes that apply and complete Items 4-14:28 Full Signature (required) DateSocial Security Number:(Voluntary. See Instructions in section D):Mailing address (if different from residence address above in section A):413 BirthDate:Month Day YearGender:6 Male Female510 Party:7 Daytime Phone: New Registration Party Affiliation Change Address Change3 Under penalty of
YOU MUST REGISTER WITH A POLITICAL PARTY IF YOU WANT TO TAKE PART IN THAT POLITICAL PARTY’S PRIMARY ELECTION, CAUCUS, OR CONVENTION. CHECK ONE BOX ONLY. For more information visit our website at www.mva.maryland.gov or call 410-768-7000. TTY for the hearing impaired: 1-800-492-4575. 6601 Ritchie Highway, N.E., Glen Burnie, …
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