18 VOTER Void Permanent Absentee Request
ELECTION OFFICE VOID PERMANENT ABSENTEE REQUEST
If you have questions, please call (877) 560-5286.
_________________________________________ Last Name
_____________________ First Name
_________________________________________ Phone Number
_______________________________________________ E-mail Address
_________________________________________ Suffix, Maiden Name, Alias(es)
_____________________ Birthdate
_____________________ Middle Name _____________________ Enrollment Number
MAILING ADDRESS: If the mailing address provided is different than what is currently on file, it will be forwarded to the Membership/CDIB Department so it can be updated.
_____________________________________ ___________________________ _______________ _______________ Street, Route, or P.O. Box City State Zip
By signing below, I wish to no longer vote in any Osage Nation election by absentee ballot. Please change my absentee voter status and remove me from the Permanent Absentee Voter list. Furthermore, I understand that in order to vote in any future Osage Nation election, I will be required to vote either in person or by submitting another Absentee Ballot Request form. __________________________________________ Signature
__________________________________________ Date
PRIVACY PROGRAM: Please send me a Privacy Program form. By participating in the Privacy Program, your name and address will be removed from public accessible lists released by the Osage Nation Election Office.
RETURN THIS FORM BY: Fax: (918) 287-5292 E-mail: [email protected] Mail: Osage Nation Election Office P.O. Box 928 Pawhuska, OK 74056 In Person: NOT a mailing address. 608 Kihekah Pawhuska, OK
FOR ELECTION OFFICE USE ONLY
If you have questions, please call (877) 560-5286.
_________________________________________ Last Name
_____________________ First Name
_________________________________________ Phone Number
_______________________________________________ E-mail Address
_________________________________________ Suffix, Maiden Name, Alias(es)
_____________________ Birthdate
_____________________ Middle Name _____________________ Enrollment Number
MAILING ADDRESS: If the mailing address provided is different than what is currently on file, it will be forwarded to the Membership/CDIB Department so it can be updated.
_____________________________________ ___________________________ _______________ _______________ Street, Route, or P.O. Box City State Zip
By signing below, I wish to no longer vote in any Osage Nation election by absentee ballot. Please change my absentee voter status and remove me from the Permanent Absentee Voter list. Furthermore, I understand that in order to vote in any future Osage Nation election, I will be required to vote either in person or by submitting another Absentee Ballot Request form. __________________________________________ Signature
__________________________________________ Date
PRIVACY PROGRAM: Please send me a Privacy Program form. By participating in the Privacy Program, your name and address will be removed from public accessible lists released by the Osage Nation Election Office.
RETURN THIS FORM BY: Fax: (918) 287-5292 E-mail: [email protected] Mail: Osage Nation Election Office P.O. Box 928 Pawhuska, OK 74056 In Person: NOT a mailing address. 608 Kihekah Pawhuska, OK
FOR ELECTION OFFICE USE ONLY
