Telephone Number: Optional. The telephone number is used only to
verify information with the applicant, if needed.
Date: The date the voter has completed and signed the voter
** Signature of Applicant or Agent: A signature of applicant or
Agent is required on all applications. A husband, wife, mother, father, son
or daughter may act as an agent to register one another with the voterís
consent. If a person is unable to sign the application, have them make a
mark in the appropriate space, witness their "mark" with your