HomeMy Public PortalAboutAnnual Town Census - BlankIMPORTANT LEGAL DOCUMENT
IMPORTANT: State law requires that you be sent an annual street listing. Please update the information below.
Please sign and respond within ten (10) days, evenif no changes are necessary
For assistance, call TOWN CLERK 508-896-4506
Precinct «If this address is incorrect, make corrections below:
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**If there is no party information next to your name, you
are not registered to vote. If you wish to register to
vote, you may register in-person or by mail.
Warning:Failure to respond to this mailing shall result in removal from the active voting list and may result
in removal from the voter registration rolls.
Instructions:Please print. Update the information provided by adding, deleting, or making changes below the printed
information. Designate the head of your household by marking an "X" in the second column next to the name.
The eighth colmn labeled Moved/Deceased asks if the person(s) listed have moved or are deceased. Enter
an "M" or "D" if appropriate.
THIS FORM DOES NOT REGISTER YOU TO VOTE
NAME
Last First Middle
Mail toDate of
Birth Occupation Party
Nationality
if not US
citizen
Moved/
Deceased US VETERAN
Signature Date
Signed under the Penalties of Perjury as Prescribed by M.G.L. 56 §4.
ANNUAL STREET LISTING