Application To Purchase Or View Voter Registration Information (Page 2 of 2) in pdf

Application to Purchase or View Voter Registration Information

AGREEMENT

ADDITIONAL I NFORMATION

Information f urnished o n t his a pplication i s s ubject t o v erification. T he A pplicant h ereby

agrees t hat t he a forementioned i nformation s et f orth i n A ffidavits o f R egistration o f v oters

What i s A vailable

and a ny i nformation d erived f rom s aid e lectronic d ata p rocessing i nformation ( hereinafter

Current v oter f ile c ontaining v oters w ith a ctive s tatus f or S an M ateo C ounty. Y ou m ay a lso

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collectively r eferred t o a s “ registration i nformation”) w ill b e u sed O NLY F OR E LECTION,

specify c ertain s chool/special d istricts, c ities o r p recincts o r v oters w ith i nactive s tatus.

SCHOLARLY, P OLITICAL, J OURNALISTIC O R G OVERNMENTAL P URPOSES, a s d efined

This f ile w ill c ontain:

by T itle 2 , D ivision 7 , A rticle 1 , S ection 1 9003 o f t he C alifornia C ode o f R egulations, a nd

First n ame / l ast n ame

Elections C ode S ection 2 194 a nd G overnment C ode S ection 6 254.4.

Residence a nd m ailing a ddress

Precinct n umber / g roup

The A pplicant ( as p rincipal o r a gent) f urther a grees N OT t o s ell, l ease, l oan o r d eliver

Birth d ate a nd b irthplace

possession o f t he r egistration i nformation, o r a c opy t hereof, o r a ny p ortion t hereof, i n

Telephone n umber

any f orm o r f ormat, t o a ny p erson, o rganization o r a gency w ithout f irst s ubmitting a n ew

Date o f r egistration

application a nd r eceiving w ritten a uthorization f rom t he S an M ateo C ounty E lections

Permanent V ote B y M ail v oter s tatus

Office t o r elease s uch r egistration i nformation.

Political P arty

Email a ddress

WILLFUL V IOLATION O F T HESE P ROVISIONS I S A M ISDEMEANOR.

( ELECTIONS C ODE

Date l ast v oted

§18109

Voting h istory f or c ounty-‐wide e lections f rom t he l ast 5 s cheduled s tatewide e lections.

(Voting h istory f rom o ther e lections a vailable u pon r equest. I ndicate o n f ront o f f orm

In a ddition, s ubject t o p rovision o f T itle 2 , D ivision 7 , A rticle 1 , S ection 1 9001 t hrough

under “ Additional I nformation”)

19007 o f t he C alifornia C ode o f R egulations, t he A pplicant a grees t o p ay t he S tate o f

A V ote B y M ail f ile i s a vailable u pon r equest.

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California, a s c ompensation f or a ny U NAUTHORIZED U SE O F E ACH I NDIVIDUAL’S

Election R esults f rom 2 003 t o d ate a re a vailable o n

. S tatements

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REGISTRATION I NFORMATION, a n a mount e qual t o t he s um o f f ifty c ents ( $.50)

of V otes C ast f or t he 1 992 t hru t he m ost r ecent E lection a re a vailable e lectronically. E arlier

multiplied b y t he n umber o f t imes e ach r egistration r ecord i s u sed b y t he a pplicant i n a n

precinct-‐by-‐precinct S tatements o f V otes C ast a re a vailable i n p aper c opies.

unauthorized m anner.

Digital M aps a re a vailable i n P DF f ormat o n C D-‐ROM o r F TP u p/download. D ue t o m egabyte

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“I c ertify u nder p enalty o f p erjury, u nder t he l aws o f t he S tate o f C alifornia, t hat t he

limits, t hey a re n ot a vailable v ia e mail. P rinting s uggestions a re i n U ser’s G uide.

foregoing i nformation p rovided b y m e i s t rue a nd c orrect.”

Permissive a nd N on-‐Permissive A ccess t o V oter R egistration

Election C ode S ection 2 187, 2 188, 2 194; G overnment C ode 6 254.4

SIGNATURE O F A PPLICANT O R A GENT

Persons w ho h ave a ccess t o A LL V OTER I NFORMATION i nclude t hose w ho a re u sing t he

information f or t he f ollowing:

PRINT N AME O F A PPLICANT O R A GENT

ELECTION P URPOSES: V oter r egistration i nformation m ust b e m ade a vailable t o a nyone

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wishing t o c ommunicate w ith v oters i n c onnection w ith a ny e lection. F or e xample, p ersons,

RESIDENTIAL A DDRESS ( street n umber a nd n ame)

who a re i n c onnection w ith a s pecific c andidate o r c ampaign, w ish t o r un a p hone b ank, w alk

precincts.

SCHOLARLY P URPOSES: S tudents w orking o n a t hesis, p rofessors r esearching v oting

CITY

STATE ZIP C ODE

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patterns a nd o ther a cademics i nvolved i n r esearch.

JOURNALISTIC P URPOSES: M embers o f t he p ress a re p ermitted a ccess.

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POLITICAL P URPOSES: F or e xample, p ersons w ishing t o c ommunicate w ith v oters

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Executed a t:

concerning l egislation, v endors w ho p rovide i nformation o nly t o c andidates, b allot m easure

committees, p olitical p arties a nd p ersons o r o rganizations c ommunicating w ith t he v oters

City

County

State

Date

about p olitical i ssues w hether o r n ot t his u se i s i n c onjunction w ith a s pecific e lection.

GOVERNMENTAL P URPOSES: F or e xample, t he J ury C ommissioner, D istrict A ttorney,

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FOR O FFICE U SE O NLY

Public D efender o r o ther p ublic g overnment a gency.

DATE R EQUEST R ECEIVED

VERIFIED B Y

Examples o f p ersons w ho D O N OT H AVE A CCESS t o v oter r egistration i nformation:

Persons s eeking t o l ocate l ost r elatives.

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AMOUNT D UE

CHECK N UMBER

Persons, s uch a s p rivate i nvestigators, s kip t racers, p rocess s ervers a nd a ttorneys, s eeking t o

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locate i ndividuals, u nless t hose p ersons a re e mployed b y o r h ave b een c ontracted b y a p ublic

DATE P AID

IDENTIFICATION P ROVIDED

government a gency.

DATE D ATA R EQUEST

MULTIPLE D ATA R EQUESTS

COMPLETED

Application To Purchase Or View Voter Registration Information Page 2

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