Petition in Lieu of Qualifying Fee Form (2)
CITY OF MIAMI BEACH
PETITION IN LIEU OF QUALIFYING FEE
Date of birth or Registration #
Fecha de nacimiento 0
numero de inscripci6n
Dat nesans oswa nimewo
enskripsyon
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Print name
Escriba su nombre en letra de molde
Ekri non an gwo let
Residence address
Domicilioo
Adres kay
Signature
Firma
Siyati
1)
Date1FechalDat:
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2)
Date/Fecha/Dat:
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3)
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Date1FechalDat:
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4)
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Date/Fecha/Dat:
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Date/FechaJDat:
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Date/FechaJDat:
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7)
Date/Fecha/Dat:
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8)
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Date/FechalDat:
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Date/Fecha/Dat:
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F:\CLER\CLER\ELECTION\2007 Nov 6 General Election\Petitiion in Lieu of Qualifying fee form-blank.doc