Free Request Form - West Virginia

Request for West Virginia Statewide Voter Data Services
In accordance with West Virginia Code §3-2-30, voter lists will be made available through the West Virginia Secretary of State's office. The database is a real-time statewide voter database. Voter information is maintained on the county level. Although every effort is made to ensure the accuracy of the information we distribute, we cannot assume liability for inaccurate or incomplete data. The user assumes all liability associated with the use of such lists. Voter registration lists will include at least the voters: < Name < Residence address < Political party affiliation < Status Other information, which may be available, includes: County of residence < < Mailing address Districts (Congressional, Senatorial, Delegate and Magisterial) < < Precinct number Voting history < Paper Lists may be sorted: Alphabetically < < By political party By county <

NO list may include phone number or social security number.
Costs of Lists Paper List File on CD $0.015 per name $0.015 per name (plus $10.00 for each CD used)

(Available in MS Excel Spreadsheet or MS Access Database)

How to Order a Voter List The Request for Statewide Voter Data Services form must be used when requesting a voter list. The request may be faxed. Total cost of list is due within 2 working days of receipt of request and before delivery of voter list. Requests are filled on a first-come, first served basis. If the deadline for payment is missed, your request will be moved to the end of the request list. The Secretary of State's office accepts the following forms of payment: Cash, Check (made payable to the WV Secretary of State), Prepaid Account and Credit Card (MasterCard, Visa, Discover, American Express).

Request for West Virginia Statewide Voter Data Services
Counties Requested: _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________

Include on List: (check or complete all that apply) voter name residence address political party affiliation status county of residence mailing address district (give name/number of district(s) to be included in list) Congressional Senatorial Delegate Magisterial precinct # voter history registration date __________ __________ __________ __________ __________

Sort Options: Alphabetically By political party affiliation By county Other _______________ Format Options: Paper (printed hard copy) CD ___ ___ ___ (please specify file format) Microsoft Excel Spreadsheet Microsoft Access Database ASCII Text File (.txt)

No voter registration list may be used for commercial or charitable solicitations or advertising, sold or reproduced for resale, or provided to any person at less than the prescribed cost for any purpose other than official.
The statement below must be completed before purchasing a voter list from the West Virginia Secretary of State's office.

I, _________________________, for ____________________________ understand that West
(name of purchaser) (name of organization, if any)

Virginia law prohibits the sale and use of the list of registered voters for commercial or charitable solicitations or advertising, and that I or my organization may not sell the list, or reproduce it for resale. I hereby certify that the purposes for which the names and addresses of voters will be used is not in violation of this prohibition. ________________________________ Signature ________________________________ Date

Name of Purchaser: Phone number: Address:

______________________________ ____________________ ________________________________________________

________________________________________________

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