Data Request Form 02062023

REQUEST FOR VOTER REGISTRATION DATA, MAPS OR PETITION SIGNATURES

REQUESTOR INFORMATION

Requestor's Name/Group*

Street Address*

City/State/Zip*

Day Phone*

Evening Phone

Contact Person*

E Mail Address*

Date*

Signature*

OUTPUT FORMAT AND COST - Please make selection(s) below.

Use the “Other Requested Information” section to specify your request (i.e. citywide, ward, ANC, SMD, candidate’s name & office, ballot measure title, etc.). Note: Large-Format Print Maps must be picked up at the Board’s office.

E-mail or Secure Link of Voter Registration Data - Microsoft Excel (No Charge) (The entire voter registration list can only be obtained through a secure link.)

Voter Registration List With Voter History?

NoYes

Large-Format Print Map ($10.00)Secure Link of Nominating Petition Signature Images (No Charge)Secure Link of Ballot Measure Signature Images (No Charge)

Other Requested Information

While our goal is to process all requests as soon as reasonably possible, the District of Columbia Freedom of Information Act (D.C. Official Code § 2-532(c)) permits up to 15 business days to fill a request. Payment may be made by check or money order payable to the D.C. Treasurer. There is a $30 service fee for all returned checks.

Initials*