APPLICATION FOR ENTRY ON OR A CHANGE TO THE LIST OF ELECTORS. Application form by mail, , or fax

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1 APPLICATION FOR ENTRY ON OR A CHANGE TO THE LIST OF ELECTORS Application form by mail, , or fax SECTION A Choosing the application type Application for moving (change of address) the elector concerned by this application is not entered on the list of electors at the correct address A change of address application must be accompanied by a copy of the supporting document or documents required by the application. Only the elector himself, a relative as defined by the Election Act, the spouse, or a person who cohabits with the elector in question is authorized to undertake such an application in the name of the elector. Fill out sections B and C Correction the elector concerned is entered on the list of electors but its entry includes a mistake in the surname, given name, date of birth, sex, or address A correction application must be accompanied by a copy of the supporting document or documents required by the application. Only the elector himself, a relative as defined by the Election Act, the spouse, or a person who cohabits with the elector in question is authorized to undertake such an application in the name of the elector. Fill out sections B and D Entry the elector concerned is one who is not already entered on the list of electors Most Quebecers who are at least 18 years old are already entered on the permanent list of electors. An application for entry by an elector already entered will be treated as a change of address application. In case of doubt about your entry, we encourage you to contact the Information Centre of the Chief Electoral Officer of Québec: Québec City area: Toll free elsewhere: or check out the event website of the Chief Electoral Officer of Québec monvote.qc.ca An application for entry must be accompanied by a copy of the supporting document or documents required by the application. Only the elector himself, a relative as defined by the Election Act, the spouse, or a person who cohabits with the elector in question is authorized to undertake such an application in the name of the elector. Fill out sections B and E Striking the elector concerned does not live or is no longer domiciled at the address indicated on the list of electors, is not a qualified elector, is dead, under curatorship, or no longer wishes to be entered on the list of electors Fill out sections B and F Note: Only one application per form all applications must be received no later than the 14th day before polling day. 1 of 6

2 SECTION B Identification of applicant Address Home telephone number Cell Fax Relationship of applicant to the person affected by the application: the elector himself relative* spouse an elector who cohabits new occupant person from the same electoral division * relative means the father, mother, grandfather, grandmother, stepfather, stepmother, brother, sister, step-brother, step-sister, son, daughter, step-son, step-daughter, grandson, or granddaughter. In order to accelerate the treatment of the application, if the applicant is not the elector himself, send us a copy of a piece of I.D. which mentions the name and address of the applicant. Reserved for the electoral division s office received: Electoral division: Received by: mail fax Dealt with by: Electoral division: Board of revisors: 2 of 6

3 SECTION C Application for change of address Identification of the elector concerned (if different from applicant) New domiciliary address Former domiciliary address address changed: (enter, at a minimum, the month and the year) Supporting document(s) Attach copies of the supporting document or documents required by the application. This or these documents must mention: the surname, the given name, and the date of birth of the elector concerned the surname, the given name, and domiciliary address of the elector concerned Declaration of the applicant and mandatory signature I declare that to my knowledge the information contained in this application is accurate 3 of 6

4 SECTION D Application for correction Identification and address of the elector concerned as it appears on the list of electors Address Write the information as it should appear on the list of electors Address Supporting document(s) The board of revisors can request any document necessary to make its decision. To accelerate the treatment of your application, attach a copy of a supporting document for the requested correction Declaration of the applicant and mandatory signature I declare that to my knowledge the information contained in this application is accurate 4 of 6

5 SECTION E Application for entry Identification of the elector concerned (if different from the applicant) Domiciliary address Arrival date in the municipality: (enter, at a minimum, the month and year) Permanent or temporary entry: check ( ) one of the following options The elector concerned requests a permanent entry on the list of electors this entry will thus be kept for future elections The elector concerned also wishes to be entered on: the municipal list of electors the school board s list of electors the federal voters list and he or she consents to this information being sent to Elections Canada The elector concerned requests a temporary entry on the list of electors this entry will therefore not be kept for future elections Supporting document(s) Attach copies of the supporting document or documents required for the application. This or these documents must mention: the surname, the given name, and the date of birth of the elector concerned the surname, the given name, and domiciliary address of the elector concerned Declaration of applicant and mandatory signature I declare that to my knowledge the information contained in this application is accurate and that the elector concerned by this application for entry will be at least 18 years old on the polling day, is a Canadian citizen, has been domiciled in Québec for at least six months, is not deprived of election rights, and is not under curatorship 5 of 6

6 SECTION F Application for striking Identification of the elector concerned (if different from the applicant) Given name Sex* of birth* Domiciliary address of the elector concerned * If known Reasons for striking (check the appropriate box) Personal decision of the elector concerned Temporary (valid only for the election currently in progress) Permanent (the elector concerned will be withdrawn from the permanent list of electors and must be re-entered if he or she wishes to vote in future elections) To accelerate treatment, attach a copy of a piece of I.D. of the elector concerned The elector concerned is dead To accelerate the treatment, attach a copy of the death certificate or any other document required to support the application The elector is under curatorship To accelerate treatment, attach a copy of the judgment of curatorship The elector concerned does not live at the address indicated on the list of electors The address is not the domicile of the elector concerned; instead it is a second home The elector is not a qualified elector. Specify: Declaration of applicant and mandatory signature I declare that to my knowledge the information contained in this application is accurate 6 of 6