EASTERN SHAWNEE TRIBE OF OKLAHOMA
VOTER REGISTRATION APPLICATION
1. Persons who can register. Any member of the Eastern Shawnee Tribe of Oklahoma who is 18 years of age
2. Read the oath carefully. Sign and date it in ink. If you cannot sign your name, make your mark and give
the name of the person who helped you.
Warning; all answers on this application must be true. A penalty may be
assessed for any false information given. This information will be used to
determine voter eligibility protected by the Privacy Act.
Use black ink. All areas must be filled out. After you complete this application, use proper postage and mail
to Election Board, P.O. Box 1200, Seneca, MO 64865-1200 or FAX to (888) 899-0249.
Date of Birth (MM/DD/YYYY)
Mailing address (if different from address)
If someone helped you fill out this application, give name and address.
OATH: I swear or affirm that:
I am a member of the Eastern Shawnee Tribe of Oklahoma.
I am 18 years of age or older. Or I will be 18 on or before the date of the next election.
The information is true and I reside at the address given.
Signature or Mark of Applicant
Election Board: (918) 238-5151 ext. 1065