Pennsylvania Voter Registration Application (Page 4 of 4) in pdf

Pennsylvania Voter Registration Application Page 4

Be a poll worker

I would like to be a poll worker on Election Day.

If you check either of these boxes,

I would like to be a bilingual interpreter on Election Day. I speak this language:

your county voter registration

office will contact you.

Instructions for Section 5:

Draw your map here.

Example map. Do not use this map.

How to show your address on a map

Gas

Library

If you live in a rural area and do not have a street

station

address, use the map to the right to show where you live,

with landmarks and road names.

Main St

If you are homeless,use the map to the right to show

where you spend most of your time.

How to fill in the map:

• Write the names of the roads or streets nearest to where

School

you live.

• Draw an X to show where you live.

• Use a dot to show the location of landmarks, such as

schools, churches, or stores, and identify them by name.

Fold here

Your address

Place

First-class

stamp

here

Your County Voter Registration Office address:

Fold here

Fold, tape shut, and mail to your

County Voter Registration Office.

Do not use staples.

County Voter Registration Office addresses

are listed on page 2.

Tape here

Pennsylvania Voter Registration Application Page 4