Election Judge Questionaire

ELECTION JUDGE QUESTIONNAIRE
(please print and sign)

NAME:

ADDRESS:

DATE OF BIRTH______________________________________________

PRECINCT WHERE YOU VOTE____________________________________

PHONE:(HOME) (OTHER)

PARTY PREFERENCE:
(Republican, Democrat, Libertarian, Independent)

Are you related to the County Clerk, Donna Neeley? Yes No

Are you a registered voter in Taney County? Yes No

Will you work at polling place other than your own? Yes No

Please designate maximum distance you will travel.

Are you willing to fill in as a supervisory judge? Yes No

PLEASE CHECK THE ELECTION DATES YOU WILL BE AVAILABLE TO WORK:

August 3, 2010

______ November 2, 2010
SIGNATURE:

Please return the completed form to: Donna Neeley, County Clerk
P.O. Box 156
Forsyth, MO 65653