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DEMO Page 8 - SOS Online Voter Registration

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This website is a demonstration only, completing the following form will not process your request.

Confirmation

Please confirm that all information is correct and attest to the statements below to continue.

Personal Information

First Legal Name
CHRISTINA
Middle Legal Name
ANNA BELL
Last Legal Name
LAKE

Current Address

Address 1
123 SOUTH 4TH STREET APT 123
City
ELK CREEK VILLAGES
County
Lancaster
State
Nebraska
Zip Code
34983

Additional Information

No additional information provided

Contact Information

No contact information provided

Party Affiliation

Party Affiliation
Nonpartisan

WARNING: An applicant who submits this application electronically is affirming that the information in the application is true. Any applicant who submits this application electronically knowing that any of the information in the application is false shall be guilty of a Class IV felony under section 32-1502 of the statutes of Nebraska. The penalty for a Class IV felony is up to five years imprisonment, a fine of up to ten thousand dollars, or both.