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DEMO Page 8 - SOS Online Voter Registration

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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

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Address 1

123 SOUTH 4TH STREET APT 123

City

ELK CREEK VILLAGES

County

Lancaster

State

Nebraska

Zip Code

34983

Additional Information

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No additional information provided

Contact Information

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No contact information provided

Party Affiliation

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Party Affiliation

Nonpartisan

An applicant who submits this application electronically is agreeing to the use of his or her signature from the Department of Motor Vehicles’ records of his or her motor vehicle operator’s license or state identification card for purposes of voter registration. green demo tip icon

Applicant's Oath: To the best of my knowledge and belief, I declare under penalty of election falsification that:

I live in the State of Nebraska at the address provided in this application;
I have not been convicted of a felony or, if convicted, it has been at least two years since I completed my sentence for the felony, including any parole term;
I have not been officially found to be non compos mentis (mentally incompetent); and
I am a citizen of the United States.

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 two years imprisonment and twelve months post-release supervision, a fine of up to ten thousand dollars, or both.

To the best of my knowledge and belief, I declare under penalty of election falsification that the information provided is accurate.

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Confirmation

Personal Information

Current Address

Additional Information

Contact Information

Party Affiliation

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