Beruflich Dokumente
Kultur Dokumente
PLEASE MAIL COMPLETED FORM TO: Department of Motor Vehicles Change of Address Unit, 60 State Street, Wethersfield, CT 06161
(City or Town, Zip Code, County) If you checked "NO" in response to either of these questions, do
NOT complete below this line as you cannot register to vote.
MAILING ADDRESS
Check here if this is a new mailing address Do you wish to enroll in a political party?
If different
ADDRESS (Number, Street and if applicable, Box number) YES NAME OF PARTY: DEMOCRATIC REPUBLICAN
OTHER:
(City or Town, Zip Code)
I consent to organ and tissue donation and wish to be in the donor registry
I no longer wish to be in the donor registry **Voter registrations without signatures will not be processed.
SIGNATURE OF APPLICANT* TODAY'S DATE The information that I have provided is true to the best of my knowledge under penalty
of perjury. If I have provided false information, I may be subject to a fine or
imprisonment or both under federal or state laws.
*Forms without a signature will not be processed. By signing this application form, you agree to allow the signature from your license
record to be used as the signature on your voter registration record.
SECTION C
VEHICLE REGISTRATION INFORMATION VESSEL INFORMATION
CT TOWN AND STREET ADDRESS WHERE VEHICLE IN THE NORMAL COURSE OF
PLATE NUMBER CT/NUMBER
OPERATION MOST FREQUENTLY LEAVES FROM, RETURNS TO OR REMAINS