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2. PERMANENT ABSENT VOTER LIST REQUEST
   Please add me to the permanent absent voter list so I will automatically receive absentee applications in the mail before every election.
4. Name- First
5. MI
6. Last
8. Address
10. City
11. State
12. Zip Code
14. Birth Year
16. Phone Number
18. Email Address
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20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

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