Pre-Election Certification Pre-Election Certification First Name* First Last Name* Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneCell PhoneWork PhoneRegistered to Vote in Ward/Precinct: Party Affiliation:* Email* ConfirmationBy clicking Submit, I certify that I am a registered voter in the Ward in which I am seeking to serve; I am NOT a candidate for election to public office; I have NOT been convicted of an election offense; I am able to perform the essential duties of a commissioner described on Pg. 75 in the Informational Pamphlet by the Secretary of State pursuant to R.S. 18:421(C); I watched the training video in its entirety; and that the information herein is True and Correct.
