Request to remove in information from Michiganvoters.info pages

Last name: _____________________________________________

Given name(s):________________________________________

Michigan voter ID number:

______________________________________________________

Address as shown on MICHIGANVOTERS.INFO: 


______________________________________________________

______________________________________________________


Birth year as shown on MICHIGANVOTERS.INFO:   ___________

I attest that I am the person whose information appears above,
and I hereby ask Tom Alciere to remove information about me 
from his website pages.


__________________________________________  Date_______________20____

Signed and attested before me, a notary public, on this the ________

day of _____________________20_____



__________________________________

My commission expires____________________20______

This form must be notarized so we know it's really you making the request. You must
also write the webmaster's name (Tom Alciere) correctly in addressing the envelope.
If you are worried about check forgery, sign with your other hand, so it won’t match the
signature card at the bank.
Mail this form to: Tom Alciere, PO Box 106, Nashua NH 03061.
Regular mail works best.