"Registration Form for Voter Registration Solicitors" - Missouri

Registration Form for Voter Registration Solicitors is a legal document that was released by the Missouri Secretary of State - a government authority operating within Missouri.

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Download "Registration Form for Voter Registration Solicitors" - Missouri

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This form is designed to be filled out online
for your convenience. Complete the
necessary information, print, sign and mail.
O
S
S
FFICE OF
ECRETARY OF
TATE
Print
Reset
R. A
OHN
SHCROFT
J
Elections Division
Registration Form for Voter
Registration Solicitors
NAME OF SOLICITOR (PRINT CLEARLY)
SOLICITOR’S RESIDENTIAL ADDRESS (INCLUDING STREET NUMBER, CITY, STATE AND ZIP)
SOLICITOR’S MAILING ADDRESS (IF DIFFERENT FROM ABOVE)
SOLICITOR’S PHONE NUMBER (OPTIONAL)
DO YOU EXPECT TO BE PAID FOR SOLICITING VOTER REGISTRATIONS?
YES
NO
IF THE ANSWER IS YES, PLEASE PROVIDE THE NAME OF THE PERSON OR ENTITY THAT YOU EXPECT TO
RECEIVE PAYMENT FROM
I HEREBY SWEAR OR AFFIRM UNDER PENALTY OF PERJURY THAT ALL STATEMENTS MADE BY ME ARE
TRUE AND CORRECT.
SIGNATURE
DATE
ANY VOTER REGISTRATION SOLICITOR WHO KNOWINGLY FAILS TO REGISTER WITH THE SECRETARY OF
STATE IS GUILTY OF A CLASS THREE ELECTION OFFENSE.
VOTER REGISTRATION SOLICITORS SHALL REGISTER FOR EVERY ELECTION CYCLE THAT BEGINS ON THE
DAY AFTER THE GENERAL ELECTION AND ENDS ON THE DAY OF THE GENERAL ELECTION TWO YEARS
LATER. A VOTER REGISTRATION SOLICITOR SHALL BE AT LEAST EIGHTEEN YEARS OF AGE AND SHALL BE A
REGISTERED VOTER IN THE STATE OF MISSOURI. 115.205.1
SECRETARY OF STATE’S FAX NUMBER: 573.526.3242
This form is designed to be filled out online
for your convenience. Complete the
necessary information, print, sign and mail.
O
S
S
FFICE OF
ECRETARY OF
TATE
Print
Reset
R. A
OHN
SHCROFT
J
Elections Division
Registration Form for Voter
Registration Solicitors
NAME OF SOLICITOR (PRINT CLEARLY)
SOLICITOR’S RESIDENTIAL ADDRESS (INCLUDING STREET NUMBER, CITY, STATE AND ZIP)
SOLICITOR’S MAILING ADDRESS (IF DIFFERENT FROM ABOVE)
SOLICITOR’S PHONE NUMBER (OPTIONAL)
DO YOU EXPECT TO BE PAID FOR SOLICITING VOTER REGISTRATIONS?
YES
NO
IF THE ANSWER IS YES, PLEASE PROVIDE THE NAME OF THE PERSON OR ENTITY THAT YOU EXPECT TO
RECEIVE PAYMENT FROM
I HEREBY SWEAR OR AFFIRM UNDER PENALTY OF PERJURY THAT ALL STATEMENTS MADE BY ME ARE
TRUE AND CORRECT.
SIGNATURE
DATE
ANY VOTER REGISTRATION SOLICITOR WHO KNOWINGLY FAILS TO REGISTER WITH THE SECRETARY OF
STATE IS GUILTY OF A CLASS THREE ELECTION OFFENSE.
VOTER REGISTRATION SOLICITORS SHALL REGISTER FOR EVERY ELECTION CYCLE THAT BEGINS ON THE
DAY AFTER THE GENERAL ELECTION AND ENDS ON THE DAY OF THE GENERAL ELECTION TWO YEARS
LATER. A VOTER REGISTRATION SOLICITOR SHALL BE AT LEAST EIGHTEEN YEARS OF AGE AND SHALL BE A
REGISTERED VOTER IN THE STATE OF MISSOURI. 115.205.1
SECRETARY OF STATE’S FAX NUMBER: 573.526.3242