Form C03pfd - Alaska Voter Registration Application

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ALASKA VOTER REGISTRATION APPLICATION
Use this form ONLY to register to vote; change your address, name or party affiliation.
When completed, lift and fill out appropriate PFD applications.
You must fully complete a dividend application to be eligible for the dividend program.
For Office Use Only
Alaska Residence Address - Where You Live (Do not use PO, PSC HC or RR Box)
ALASKA
Codes/Comments/Initials
(Select ONLY one Party Choice)
City:
State:
County:
Zip Code:
15. VOTER CERTIFICATE: Read and sign below
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WARNING: If you provide false information on this application you can be convicted of a misdemeanor.
SIGNATURE:______________________ DATE:_______________
FOR OFFICE USE ONLY
_____________________________
____________________________
Batch Number
No. of Applications Received
*Optional – Voter number, SSN, place of birth, date of birth, and telephone number are kept confidential and used for identification
only
C03PFD (REV 8/99)

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