Public Service Request Voter Registration (Historic)
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Public Service Request Voter Registration (Historic)
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PSR
REQUEST for VOTER REGISTRATION DATA
Name:
Address:
City, State, Zip:
Telephone #:
Voter registration data is to be used for what purpose?
NOTICE OF APPROPRIATE USE
Section 115.158 RSMo prohibits commercial use of Centralized Voter Registration System Information.
The statute states: “….Any information contained in any state or local voter registration system,
limited to the master voter registration list or any other list generated from the information, subject to
chapter 610, RSMo, shall not be used for commercial purposes; provided, however, that the information
can be used for elections, for candidates, or for ballot measures, furnished at reasonable fee. Violation of
this section shall be a class B misdemeanor.”
By your signature below, you represent that you will not use, nor will you knowingly or
negligently permit others to use, this information for commercial purposes.
Cost for Data Requested
A. Voter registration list by precinct, district, election, etc $0.10 letter/page
B. Entire county on CD $10.00/ CD
NOTE: There may be a physical as well as mailing address shown for the registrant on the CD. If
you are using data for a mailing, please make sure that you are using the OPTAD fields (if
applicable) to ensure that it is sent to the correct address.
C. Voter address labels $0.35/ sheet of labels
Detailed explanation of data request:
X
Signature Date of request
**************************For office use**************************
Date Done: By:
Total Cost: $ Date Paid: Rec’d by:
Treasurer’s Office Receipt #:
Public Service Request Voter Registration (Historic)
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