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 perjury, I hereby swear or affirm: I am a citizen I am a Maryland resident I am at least 16 years old I have not been convicted of buying or
MVA of any change in your address within thirty (30)days of the change. NOTE: If you have changed your name, you must visit a full service MVA branch to obtain a corrected driver's license or ID. 1. In Section A of the reverse side, copy all information directly from your present driver's license/ID card (be sure to include your
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