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Permanent Absentee Voter List

2. First Name*

3. Last Name*

4. Year of Birth*

6. Address*

7. CITY/STATE/ZIP
   Fraser, MI 48026

   Fraser, MI 48026

11. Would you like all elections mail to be sent to an alternate address?*
    -- Select One --YesNo

12. Alternate Address

    Street #/ City/ State/ Zip Code

14. How can we contact you?*
    -- Select One --PhoneEmailMail Only

    This information is for city use only.

15. Contact Information*

19. Signature*

    Please type in your first and last name to confirm that you are requesting to be placed on the City of Fraser's Permanent Absentee List.

20. Today's Date*
    Today's Date

Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field