Form Ds De 18 Nvra Complaint - Florida Department Of State printable pdf download

NVRA COMPLAINT

For Alleged Violation of the National Voter Registration Act of 1993 or of a Voter Registration

or Removal Procedure under the Florida Election Code

Pursuant to section 97.023, Florida Statutes, the Department of State, Division of Elections has primary jurisdiction

over complaints of alleged violations of the National Voter Registration Act of 1993 (42 U.S.C. 1973gg-1 et seq.), or

violations of a voter registration and removal procedures under the Florida Election Code. A complaint hereunder

can only be filed if the alleged violation is committed by the Department of State, a voter registration agency, a

county supervisor of elections, the Department of Highway Safety and Motor Vehicles or an Armed Forces

Recruitment Center. Upon the filing of a complaint, you will be given the opportunity to resolve the complaint

through an informal dispute resolution process.

Please return completed complaint to: Florida Department of State, c/o NVRA Coordinator, Division of Elections,

Floor, R.A. Gray Building, 500 S. Bronough Street, Tallahassee, Florida 32399-0250. Contact (850) 245-6200 for further

assistance.

PERSON BRINGING COMPLAINT

Name ____________________________________________ Day Phone _____________Evening Phone _________

Address __________________________________________ City__________________________________________

County ___________________________________________ State _________________ Zip Code_______________

E-mail address (optional):_________________________________________________________________________

PERSON OR ENTITY AGAINST WHOM COMPLAINT IS BROUGHT

(limit one person/entity per form)

Name ____________________________________________ Day Phone _____________Evening Phone _________

Address __________________________________________ City__________________________________________

County ___________________________________________ State _________________ Zip Code_______________

VIOLATION

If you believe you have been denied the right to register to vote, to update your existing voting registration

record, or have been unlawfully removed from the registration books in violation of the National Voter

Registration Act of 1993 (42 U.S.C. 1973gg-1 et seq.), or in violation of the Florida Election Code, please state

the specific acts committed by the person or entity named in this complaint:

________________________________________________________________________________________

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Form DS DE 18 (eff. 01/06)

Form Ds De 18 Nvra Complaint - Florida Department Of State