Transcription of VR-154 (05-17) - MVA
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VR-154 (05-17) - MVA
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 selling votes I have not been convicted of a felony, or if I have, I have completed serving a court-ordered sentence of imprisonment.
A commercial driver must obtain a corrected license whenever the commercial driver changes his or her mailing address. White Copy - Board of Elections Canary Copy - MVA Pink Copy - Customer Giving false information on an application for voter registration is perjury, punishable by imprisonment for up to 10 years, and a
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