INSTRUCTIONS FOR COMPLETING THE WIKIWIKI VOTER REGISTRATION FORM

Filip

ino,

Chi

nese

, and

Jap

anes

e tr

ansl

atio

ns a

re re

qui

red

p

ursu

ant t

o th

e Vo

ting

Rig

hts

Act

of 1

965

as a

men

ded

.

For

mor

e in

form

atio

n, p

leas

e ca

ll th

e O

ffi ce

of

the

City

/Cou

nty

Cle

rk:

H

onol

ulu:

(8

08)

768-

3800

M

aui:

(8

08)

270-

7749

K

auai

: (8

08)

241-

4800

H

awai

i:

(808

) 96

1-82

77

Alo

ha

Th

e O

ffic

e o

f E

lec

tio

ns

an

d t

he

Ass

oc

iati

on

of

Cle

rks

an

d E

lec

tio

n O

ffic

ers

of

Ha

wa

ii a

re p

lea

sed

to

intr

od

uc

e y

ou

to

Wik

iwik

i V

ote

r R

egis

trat

ion,

Haw

aii’s

reg

istr

atio

n-b

y-m

ail p

roce

dur

e.

To r

egis

ter

to v

ote,

all

you

need

is a

W

ikiw

iki

form

an

d a

po

sta

ge

sta

mp

. Fo

llow

the

ins

truc

tions

and

com

ple

te

the

fo

rm c

orr

ec

tly.

On

ce

yo

u h

ave

re

gis

tere

d t

o vo

te,

ple

ase

rem

emb

er

to t

ake

the

next

ste

p a

nd V

OTE

in t

he

upco

min

g e

lect

ions

. See

you

ther

e!

VO

TE

RR

EG

ISTR

ATIO

N

LA

NG

UA

GE

AS

SIS

TAN

CE

1. Print your Social Security Number. 2. Print your Date of Birth.3. Print your “Home” and “Business” telephone numbers.4. Print your Name - Last, First and Middle Initial(s).5. Print your Residence Address in Hawaii (house number and street name). You must be registered to

vote in the county and precinct where you live. Note: A Post Office Box, Star Route, Rural Route, General Delivery, Business Address or Mailing Service Address is not an acceptable residence address.6. Print your Mailing Address in Hawaii.7. If your residence does not have a street address, describe the location of your residence. Include

details such as subdivision, village, tax map key no. and zip code.8. Check the appropriate “Female” or “Male” box.9. If you are registered to vote in another state but now wish to register to vote in Hawaii, complete box #9.

Your registration in that state will be canceled. Note: You may register to vote in only one state.10. Read carefully, mark the appropriate “Yes” or “No” box and sign on the line provided. Your application

will not be accepted if you fail to mark the appropriate boxes or withhold your signature.11. If your signature is a mark, a witness signature is required.

STEP 2 Mail the Affidavit on Application for Voter Registration no later than 30 days prior to the election to the appropriate City/County Clerk:

STEP 1 Complete the Affidavit on Application for Voter Registration

County of Hawaii 25 Aupuni St., Rm. 105Hilo, HI 96720-4245Ph. (808) 961-8277

City and County of Honolulu530 S. King St., Rm. 100Honolulu, HI 96813-3077Ph. (808) 768-3800

County of Maui200 S. High St., Rm. 708Wailuku, HI 96793-2155Ph. (808) 270-7749

County of Kauai4386 Rice St.Lihue, HI 96766-1371Ph. (808) 241-4800

Notice to First Time Voters Who Register to Vote by Mail:

If you are (1) registering to vote for the fi rst time in the State of Hawaii; and (2) are mailing in this Affi davit on Application for Voter Registration, federal law (42 U.S.C. § 15483) requires you to provide proof of identifi cation. Proof of identifi cation includes a copy of:

• A current and valid photo identifi cation, or• A current utility bill, bank statement, government check, paycheck or government document that shows your name and

address.

If you do not provide the required proof of identifi cation with this Affi davit on Application for Voter Registration, you will be required to do so at your polling place, or with your voted absentee mail-in ballot.

Tulo

ng

par

a it

i L

eng

gu

ahe

– F

ilip

ino

(Il

oca

no

) Ti

Op

isin

a ti

Pan

agp

ipili

ken

ti

Tim

puy

og d

agiti

E

sk

rib

ien

te k

en

Ele

ks

ion

Op

ise

r ti

Ha

wa

ii m

arag

saka

nda

a m

ang

iyam

mo

kenk

a ti

Wik

iwik

i a

Pan

agre

hist

ro ti

Bot

ante

, ti P

anag

rehi

stro

iti H

awai

i b

ab

ae

n t

i ko

reo

a w

ag

as.

D

ag

iti n

aip

ata

rus

a ka

sap

ula

n i

ti p

an

ag

bu

tos

a m

an

gtu

lon

g k

en

ka

iti p

anan

gile

pp

as it

i day

toy

a p

orm

a m

aala

da

iti

Op

isin

a t

i E

skri

bie

nte

iti

Siu

da

d/I

li. P

an

ga

asi

m

ta a

wag

anyo

ti m

aitu

top

a n

umer

o iti

tel

epon

o a

naila

nad

dito

y b

aba.

言語サービス

– J

apan

ese

この度、選挙人名簿登録が郵便で行えるようになりま

した。これは選挙管理委員会

(The

Offi

ce o

f Ele

ctio

ns)

並びに書記官、選挙管理員協会 (T

he A

ssoc

iatio

n of

C

lerk

s an

d E

lect

ion

Offi

cers

of H

awai

i) 発行の「ウィ

キウィキ選挙人名簿登録申請用紙」です。この申請用

紙記入の際に必要な手引き書の日本語訳は最寄りの

市または郡の書記官事務所 (T

he O

ffice

of t

he C

ity/

Cou

nty

Cle

rk) より入手できます。ご入り用の際は下記

の番号にお問い合わせください。

En

glis

h (

Tran

slat

ion

)

The

Offi

ce o

f Ele

ctio

ns a

nd th

e A

ssoc

iatio

n of

Cle

rks

and

Ele

ctio

n O

f fic

ers

of H

awai

i ar

e p

leas

ed t

o in

trod

uce

you

to W

ikiw

iki V

oter

Reg

istra

tion,

Haw

aii’s

re

gis

trat

ion-

by-

mai

l pro

ced

ure.

Tr

ansl

ated

vot

ing

m

ater

ials

to

assi

st y

ou in

com

ple

ting

thi

s fo

rm a

re

avai

labl

e at

the

Offi

ce o

f the

City

/Cou

nty

Cle

rk.

Plea

se

call

the

appr

opria

te p

hone

num

ber l

iste

d be

low

.

– C

hin

ese

Any voter who requires assistance to vote by reason of physical, visual, or hearing disability, or an inability to read or write may be given assistance by a person of the voter’s choice -- other than the voter’s employer, agent of the employer, or agent of the voter’s union (42 U.S.C. 1973aa-6).

Every polling place has a Voter Assistance Official who can provide the following:

language assistance materials to voters who have difficulty with the English language; assistance to voters with physical disabilities; and curbside voting services to voters who are unable to leave their vehicles to vote.

VOTING IN HAWAII

SPECIAL VOTING SERVICES

Voting is an essential part of our democratic process. By voting, you choose the representatives who will make decisions affecting you, your family and your community. If you care about the future of Hawaii. . . .register and VOTE!!

What Types of Elections Does Hawaii Hold?

In every even numbered year, Hawaii holds a Primary Electionin September and a General Election in November.

Who May Register to Vote?

You may register to vote if you are: a citizen of the United States of America; a legal resident of Hawaii; and at least 16 years of age (Pre-registration is allowed at

age 16. You must be 18 years old by election day to vote).

You are not eligible to register or to vote if you are a convicted and confined felon or you are declared mentally incompetent.

Should I Re-register to Vote?

You should re-register if you changed your name, residence address or mailing address.

How Long are the Polls Open?

Polling places are open from 7:00 A.M. to 6:00 P.M. If you are not sure of your polling place, call your City or County Clerk.

Will I Be Notified of My Polling Place?

Yes. Your City/County Clerk will send you a Notice of Voter Registration and Address Confirmation (NVRAC) card with your polling place listed on it.

You are not properly registered if: you do not receive the NVRAC card; you no longer live at the address listed on the

NVRAC card; or your residence address on the NVRAC is the address of a

mailing service or a business.

Do I Need an I.D. to Vote on Election Day?

Yes. Be sure to have an I.D. with a picture and signature (such as a Hawaii driver’s license or state I.D. card) when you go to vote. The NVRAC card is not an acceptable form of identification.

Do I Have to Take Time Off from Work to Vote?

You may be entitled to not more than two consecutive hours off from work on election day in order to vote. Ask your employer first and keep your ballot stub as proof of voting (ref. HRS §11-95).

For additional information, call the Voter Hotline at:

(808) 453-VOTE (8683)

Neighbor Islands call toll-free:

1-800-442-VOTE (8683)

Website address: www.hawaii.gov/elections

Persons with hearing or speech disabilities should call the Office of Elections’ TTY phone at:

(808) 453-6150

Neighbor Islands call TTY toll-free:1-800-345-5915

or the Sprint Relay Hawaii TRS at:711 (V/TTY); 847-9508 (FAX)

Voice Carry Over (VCO): 1 (877) 447-5992Speech to Speech (STS): 1 (877) 447-8711

Prepared by the Office of Elections and the Association of Clerks and Election Officers of Hawaii (05/08).

WARNINGWARNING

AFFIDAVIT ON APPLICATION FOR VOTER REGISTRATION

STATE OF HAWAIICounty of HawaiiCounty of KauaiCounty of MauiCity and County of Honolulu

IMPORTANT: PRINT CLEARLY IN BLACK INK. FAILURE TO COMPLETE ALL ITEMS WILL PREVENT ACCEPTANCE OF THIS APPLICATION.

I HEREBY SWEAR (OR AFFIRM) THAT THE FOLLOWING INFORMATION IS TRUE AND CORRECT:

AFFIDAVIT NO.

(FOR OFFICE USE ONLY)}ss.

The office at which a person registers to vote is confidential. A person’s declination to register to vote is also confidential and is used for voter registration purposes only (National Voter Registration Act of 1993).

ANY PERSON WHO KNOWINGLY FURNISHES FALSE INFORMATION MAY BE GUILTY OF A CLASS C FELONY, PUNISHABLE BY UP TO 5 YEARS OF IMPRISONMENT AND/OR $10,000 FINE.

* Notice: Section 11-15 of the Hawaii Revised Statutes requires that a person registering to vote provide, under oath, his or her social security number, if any.An application lacking this information will, therefore, be denied. Pursuant to Section 7 of the Federal Privacy Act (P.L. 93-579), be advised that this information may be released to government agencies for government purposes.

For Offi ce Use Only

05/08

1SOCIAL SECURITY NUMBER*

___ ___ ___ - ___ ___ - ___ ___ ___ ___ 2DATE OF BIRTH

___ ___ / ___ ___ / ___ ___ Month Day Year

3TELEPHONE

Home: Business:

4LAST NAME FIRST NAME MIDDLE INITIAL(S)

5RESIDENCE ADDRESS IN HAWAII (Must be completed. P.O. Box, R.R., S.R. are not acceptable) CITY/TOWN ZIP CODE

6MAILING ADDRESS IN HAWAII (Street address or P.O. Box) CITY/TOWN ZIP CODE

7If no street/residence address, describe location of residence (leave blank if box #5 is completed) CITY/TOWN ZIP CODE

8

GENDER

Female

Male9

ARE YOU A REGISTERED VOTER IN ANOTHER STATE?If “yes”, please complete the following: I was last registered to vote at:

(Last Registered Address) (County) (State) (Zip Code)

and hereby authorize cancellation of my previous voter registration.

10

READ CAREFULLY, MARK APPROPRIATE “YES” OR “NO” BOX, AND SIGN BELOW.

I hereby swear (or affi rm) that:

FOR FEDERAL, STATE, and COUNTY ELECTIONS:

a. I am a citizen of the United States of America (Non-U.S. citizens including U.S. nationals do not qualify). Yes No

b. I am at least 16 years of age. I understand that I must be 18 years old by election day to vote. Yes No

c. I am a resident of the State of Hawaii. The residence stated in this affi davit is not simply because of my presence in the State, but that the residence was acquired with the intent to make Hawaii my legal residence with all the accompanying obligations therein……… Yes No

11

WITNESS SIGNATURE (required only if applicant makes a mark) DATE

ADDRESS OF WITNESS PHONE NO. OF WITNESS

SIGNATUREDATE

in the county of

12I.D. No.

_____ _____ _____ _____13

LOCATION CODE

_____ _____14

REPRESENTATIVE DISTRICT/PRECINCT

_____ _____ _____ _____

Any voter who requires assistance to vote by reason of physical, visual, or hearing disability, or an inability to read or write may be given assistance by a person of the voter’s choice -- other than the voter’s employer, agent of the employer, or agent of the voter’s union (42 U.S.C. 1973aa-6).

Every polling place has a Voter Assistance Official who can provide the following:

language assistance materials to voters who have difficulty with the English language; assistance to voters with physical disabilities; and curbside voting services to voters who are unable to leave their vehicles to vote.

VOTING IN HAWAII

SPECIAL VOTING SERVICES

Voting is an essential part of our democratic process. By voting, you choose the representatives who will make decisions affecting you, your family and your community. If you care about the future of Hawaii. . . .register and VOTE!!

What Types of Elections Does Hawaii Hold?

In every even numbered year, Hawaii holds a Primary Electionin September and a General Election in November.

Who May Register to Vote?

You may register to vote if you are: a citizen of the United States of America; a legal resident of Hawaii; and at least 16 years of age (Pre-registration is allowed at

age 16. You must be 18 years old by election day to vote).

You are not eligible to register or to vote if you are a convicted and confined felon or you are declared mentally incompetent.

Should I Re-register to Vote?

You should re-register if you changed your name, residence address or mailing address.

How Long are the Polls Open?

Polling places are open from 7:00 A.M. to 6:00 P.M. If you are not sure of your polling place, call your City or County Clerk.

Will I Be Notified of My Polling Place?

Yes. Your City/County Clerk will send you a Notice of Voter Registration and Address Confirmation (NVRAC) card with your polling place listed on it.

You are not properly registered if: you do not receive the NVRAC card; you no longer live at the address listed on the

NVRAC card; or your residence address on the NVRAC is the address of a

mailing service or a business.

Do I Need an I.D. to Vote on Election Day?

Yes. Be sure to have an I.D. with a picture and signature (such as a Hawaii driver’s license or state I.D. card) when you go to vote. The NVRAC card is not an acceptable form of identification.

Do I Have to Take Time Off from Work to Vote?

You may be entitled to not more than two consecutive hours off from work on election day in order to vote. Ask your employer first and keep your ballot stub as proof of voting (ref. HRS §11-95).

For additional information, call the Voter Hotline at:

(808) 453-VOTE (8683)

Neighbor Islands call toll-free:

1-800-442-VOTE (8683)

Website address: www.hawaii.gov/elections

Persons with hearing or speech disabilities should call the Office of Elections’ TTY phone at:

(808) 453-6150

Neighbor Islands call TTY toll-free:1-800-345-5915

or the Sprint Relay Hawaii TRS at:711 (V/TTY); 847-9508 (FAX)

Voice Carry Over (VCO): 1 (877) 447-5992Speech to Speech (STS): 1 (877) 447-8711

Prepared by the Office of Elections and the Association of Clerks and Election Officers of Hawaii (05/08).

WARNINGWARNING

AFFIDAVIT ON APPLICATION FOR VOTER REGISTRATION

STATE OF HAWAIICounty of HawaiiCounty of KauaiCounty of MauiCity and County of Honolulu

IMPORTANT: PRINT CLEARLY IN BLACK INK. FAILURE TO COMPLETE ALL ITEMS WILL PREVENT ACCEPTANCE OF THIS APPLICATION.

I HEREBY SWEAR (OR AFFIRM) THAT THE FOLLOWING INFORMATION IS TRUE AND CORRECT:

AFFIDAVIT NO.

(FOR OFFICE USE ONLY)}ss.

The office at which a person registers to vote is confidential. A person’s declination to register to vote is also confidential and is used for voter registration purposes only (National Voter Registration Act of 1993).

ANY PERSON WHO KNOWINGLY FURNISHES FALSE INFORMATION MAY BE GUILTY OF A CLASS C FELONY, PUNISHABLE BY UP TO 5 YEARS OF IMPRISONMENT AND/OR $10,000 FINE.

* Notice: Section 11-15 of the Hawaii Revised Statutes requires that a person registering to vote provide, under oath, his or her social security number, if any.An application lacking this information will, therefore, be denied. Pursuant to Section 7 of the Federal Privacy Act (P.L. 93-579), be advised that this information may be released to government agencies for government purposes.

For Offi ce Use Only

05/08

1SOCIAL SECURITY NUMBER*

___ ___ ___ - ___ ___ - ___ ___ ___ ___ 2DATE OF BIRTH

___ ___ / ___ ___ / ___ ___ Month Day Year

3TELEPHONE

Home: Business:

4LAST NAME FIRST NAME MIDDLE INITIAL(S)

5RESIDENCE ADDRESS IN HAWAII (Must be completed. P.O. Box, R.R., S.R. are not acceptable) CITY/TOWN ZIP CODE

6MAILING ADDRESS IN HAWAII (Street address or P.O. Box) CITY/TOWN ZIP CODE

7If no street/residence address, describe location of residence (leave blank if box #5 is completed) CITY/TOWN ZIP CODE

8

GENDER

Female

Male9

ARE YOU A REGISTERED VOTER IN ANOTHER STATE?If “yes”, please complete the following: I was last registered to vote at:

(Last Registered Address) (County) (State) (Zip Code)

and hereby authorize cancellation of my previous voter registration.

10

READ CAREFULLY, MARK APPROPRIATE “YES” OR “NO” BOX, AND SIGN BELOW.

I hereby swear (or affi rm) that:

FOR FEDERAL, STATE, and COUNTY ELECTIONS:

a. I am a citizen of the United States of America (Non-U.S. citizens including U.S. nationals do not qualify). Yes No

b. I am at least 16 years of age. I understand that I must be 18 years old by election day to vote. Yes No

c. I am a resident of the State of Hawaii. The residence stated in this affi davit is not simply because of my presence in the State, but that the residence was acquired with the intent to make Hawaii my legal residence with all the accompanying obligations therein……… Yes No

11

WITNESS SIGNATURE (required only if applicant makes a mark) DATE

ADDRESS OF WITNESS PHONE NO. OF WITNESS

SIGNATUREDATE

in the county of

12I.D. No.

_____ _____ _____ _____13

LOCATION CODE

_____ _____14

REPRESENTATIVE DISTRICT/PRECINCT

_____ _____ _____ _____

INSTRUCTIONS FOR COMPLETING THE WIKIWIKI VOTER REGISTRATION FORM

Filip

ino,

Chi

nese

, and

Jap

anes

e tr

ansl

atio

ns a

re re

qui

red

p

ursu

ant t

o th

e Vo

ting

Rig

hts

Act

of 1

965

as a

men

ded

.

For

mor

e in

form

atio

n, p

leas

e ca

ll th

e O

ffi ce

of

the

City

/Cou

nty

Cle

rk:

H

onol

ulu:

(8

08)

768-

3800

M

aui:

(8

08)

270-

7749

K

auai

: (8

08)

241-

4800

H

awai

i:

(808

) 96

1-82

77

Alo

ha

Th

e O

ffic

e o

f E

lec

tio

ns

an

d t

he

Ass

oc

iati

on

of

Cle

rks

an

d E

lec

tio

n O

ffic

ers

of

Ha

wa

ii a

re p

lea

sed

to

intr

od

uc

e y

ou

to

Wik

iwik

i V

ote

r R

egis

trat

ion,

Haw

aii’s

reg

istr

atio

n-b

y-m

ail p

roce

dur

e.

To r

egis

ter

to v

ote,

all

you

need

is a

W

ikiw

iki

form

an

d a

po

sta

ge

sta

mp

. Fo

llow

the

ins

truc

tions

and

com

ple

te

the

fo

rm c

orr

ec

tly.

On

ce

yo

u h

ave

re

gis

tere

d t

o vo

te,

ple

ase

rem

emb

er

to t

ake

the

next

ste

p a

nd V

OTE

in t

he

upco

min

g e

lect

ions

. See

you

ther

e!

VO

TE

RR

EG

ISTR

ATIO

N

LA

NG

UA

GE

AS

SIS

TAN

CE

1. Print your Social Security Number. 2. Print your Date of Birth.3. Print your “Home” and “Business” telephone numbers.4. Print your Name - Last, First and Middle Initial(s).5. Print your Residence Address in Hawaii (house number and street name). You must be registered to

vote in the county and precinct where you live. Note: A Post Office Box, Star Route, Rural Route, General Delivery, Business Address or Mailing Service Address is not an acceptable residence address.6. Print your Mailing Address in Hawaii.7. If your residence does not have a street address, describe the location of your residence. Include

details such as subdivision, village, tax map key no. and zip code.8. Check the appropriate “Female” or “Male” box.9. If you are registered to vote in another state but now wish to register to vote in Hawaii, complete box #9.

Your registration in that state will be canceled. Note: You may register to vote in only one state.10. Read carefully, mark the appropriate “Yes” or “No” box and sign on the line provided. Your application

will not be accepted if you fail to mark the appropriate boxes or withhold your signature.11. If your signature is a mark, a witness signature is required.

STEP 2 Mail the Affidavit on Application for Voter Registration no later than 30 days prior to the election to the appropriate City/County Clerk:

STEP 1 Complete the Affidavit on Application for Voter Registration

County of Hawaii 25 Aupuni St., Rm. 105Hilo, HI 96720-4245Ph. (808) 961-8277

City and County of Honolulu530 S. King St., Rm. 100Honolulu, HI 96813-3077Ph. (808) 768-3800

County of Maui200 S. High St., Rm. 708Wailuku, HI 96793-2155Ph. (808) 270-7749

County of Kauai4386 Rice St.Lihue, HI 96766-1371Ph. (808) 241-4800

Notice to First Time Voters Who Register to Vote by Mail:

If you are (1) registering to vote for the fi rst time in the State of Hawaii; and (2) are mailing in this Affi davit on Application for Voter Registration, federal law (42 U.S.C. § 15483) requires you to provide proof of identifi cation. Proof of identifi cation includes a copy of:

• A current and valid photo identifi cation, or• A current utility bill, bank statement, government check, paycheck or government document that shows your name and

address.

If you do not provide the required proof of identifi cation with this Affi davit on Application for Voter Registration, you will be required to do so at your polling place, or with your voted absentee mail-in ballot.

Tulo

ng

par

a it

i L

eng

gu

ahe

– F

ilip

ino

(Il

oca

no

) Ti

Op

isin

a ti

Pan

agp

ipili

ken

ti

Tim

puy

og d

agiti

E

sk

rib

ien

te k

en

Ele

ks

ion

Op

ise

r ti

Ha

wa

ii m

arag

saka

nda

a m

ang

iyam

mo

kenk

a ti

Wik

iwik

i a

Pan

agre

hist

ro ti

Bot

ante

, ti P

anag

rehi

stro

iti H

awai

i b

ab

ae

n t

i ko

reo

a w

ag

as.

D

ag

iti n

aip

ata

rus

a ka

sap

ula

n i

ti p

an

ag

bu

tos

a m

an

gtu

lon

g k

en

ka

iti p

anan

gile

pp

as it

i day

toy

a p

orm

a m

aala

da

iti

Op

isin

a t

i E

skri

bie

nte

iti

Siu

da

d/I

li. P

an

ga

asi

m

ta a

wag

anyo

ti m

aitu

top

a n

umer

o iti

tel

epon

o a

naila

nad

dito

y b

aba.

言語サービス

– J

apan

ese

この度、選挙人名簿登録が郵便で行えるようになりま

した。これは選挙管理委員会

(The

Offi

ce o

f Ele

ctio

ns)

並びに書記官、選挙管理員協会 (T

he A

ssoc

iatio

n of

C

lerk

s an

d E

lect

ion

Offi

cers

of H

awai

i) 発行の「ウィ

キウィキ選挙人名簿登録申請用紙」です。この申請用

紙記入の際に必要な手引き書の日本語訳は最寄りの

市または郡の書記官事務所 (T

he O

ffice

of t

he C

ity/

Cou

nty

Cle

rk) より入手できます。ご入り用の際は下記

の番号にお問い合わせください。

En

glis

h (

Tran

slat

ion

)

The

Offi

ce o

f Ele

ctio

ns a

nd th

e A

ssoc

iatio

n of

Cle

rks

and

Ele

ctio

n O

f fic

ers

of H

awai

i ar

e p

leas

ed t

o in

trod

uce

you

to W

ikiw

iki V

oter

Reg

istra

tion,

Haw

aii’s

re

gis

trat

ion-

by-

mai

l pro

ced

ure.

Tr

ansl

ated

vot

ing

m

ater

ials

to

assi

st y

ou in

com

ple

ting

thi

s fo

rm a

re

avai

labl

e at

the

Offi

ce o

f the

City

/Cou

nty

Cle

rk.

Plea

se

call

the

appr

opria

te p

hone

num

ber l

iste

d be

low

.

– C

hin

ese