Apd - Application For Services Form (Page 5 of 6) in pdf

Apd - Application For Services Form Page 5

Application for Services

Privacy: Your decision not to register or update your record and the location where you applied to register or update your

voter registration record is confidential and may only be used for voter registration purposes.

Formal Complaint: If you believe someone has interfered with either your right to apply to register or to decline to register

to vote, your right to privacy in deciding whether to apply to register to vote, or your right to choose your own political party

or other political preference, you may file a complaint with: Florida Secretary of State, Division of Elections, NVRA

Administrator, R.A. Gray Building, 500 S. Bronough Street, Tallahassee, Florida 32399-0250. Forms for filing a complaint

are available at

* The collection of social security number is for record keeping purposes and is imperative to the agency’s duties and responsibilities

as prescribed by law. The social security number collected will not be available to the general public.

Updated January 21, 2016

Apd - Application For Services Form Page 5