First Name Middle Name (type NMN if none) Last Name Email Address Mailing Address Line 1 Mailing Address Line 2 City State Zip Code Home Phone Number Cell Phone Number Date of Birth Gender Please selectMaleFemale Marital Status Please Select(Unknown/Not stated)Never MarriedMarriedDivorcedSeparatedWidowedDomestic Partners Did you pay money to vote? YesNo Who was the person you voted for? How much did you spend on votes? Will you sign a declaration for court? YesNo