Free Updated Voter Registration Product Order Form.indd - Wyoming

Secretary of State Voter Registration Product Order Form

Electronic Formats and Lists E-mail ......................................................................................................................... No Charge CD ...............................................................................................................................$20.00 Printed List ................................................................................................................$18.00 plus statutory charge

Statewide Voter Registration List
State alpha list of all voters. State alpha list of all voters one party (check one): R D L Other

Legislative Voter Registration List
Alpha list of all voters.

HD ____ SD ____

Alpha list of all voters in HD or SD sorted by district - precinct. Alpha list of voters' one party, sorted by district - precinct. R D L Other

County Voter Registration List
Alpha list of all voters within a county.

County Name ________________

County Number ________________

County alpha list, voters by party, sorted by district - precinct (check one):

R

D

L

Other

All

This form can be accessed on the Secretary of State's website at:
soswy.state.wy.us/election/forms.htm
Revised 3/08

Oath
I hereby affirm that I am requesting voter registration data in the capacity of (check and complete the appropriate category): Candidate for political office
Office Title

Officer of candidate's campaign committee
Title Name of Committee

Officer of political party central committee
Title Name of Committee

Elected official
Office Title

Officer of political action committee
Title Name of Committee

Individual promoting or opposing a ballot issue
Ballot Issue

Individual promoting or opposing a candidate
Candidate's Name

Representative of organization promoting voter participation
Title Name of Organization

In accordance with Wyoming Election Code, W.S. 22-2-113(a), I affirm that I will only use the above voter registration data for political purposes only and that I will not use it for commercial purposes. I also affirm that I may reproduce the registration data for political purposes only, as allowed by W.S. 22-2-113(a), but if the data is provided to others, I must notify subsequent parties of the statutory prohibition against using such data for commercial purposes. I understand that violations of W.S. 22-2-113(a) may be prosecuted as misdemeanors under W.S. 22-26-112.

Signature of Affiant

Date

Name Mailing Address City, State, Zip Telephone E-mail Address (be sure to provide for e-mail requests)

Return the completed form, oath and pre-payment to: Wyoming Secretary of State Elections Division 200 West 24th Street Cheyenne, WY 82002-0020

If you have any questions regarding the completion of this form, contact the Elections Division at the Secretary of State's Office at (307) 777-3416 or via e-mail at [email protected].