MARICOPA COUNTY ELECTIONS DEPARTMENT

							                        MARICOPA COUNTY ELECTIONS DEPARTMENT
                             111 S. Third Ave., Phoenix, AZ 85003
                                         602 506 1511
                                     Notice of Voter Move

Congressional            Supervisor        Legislative
District______           District_____     District__________     Precinct_____________________________


Name             (old address)                            Street/City/Zip Code



                 (new address, if known)                  Street/City/Zip Code



Name             (old address)                            Street/City/Zip Code



                 (new address, if known)                  Street/City/Zip Code



Name             (old address)                            Street/City/Zip Code



                 (new address, if known)                  Street/City/Zip Code



Name             (old address)                            Street/City/Zip Code



                 (new address, if known)                  Street/City/Zip Code



Name             (old address)                            Street/City/Zip Code



                 (new address, if known)                  Street/City/Zip Code




                   I HEREBY VERIFY THAT THE INDIVIDUAL(S) LISTED ABOVE
                 HAVE MOVED, AND NO LONGER RESIDE AT THE ADDRESS SHOWN


_______________________________            ___________________________                  ______________
Precinct Committeeman’s Signature          Printed Name                                   Date