VOTER INFORMATION REQUEST FORM & INVOICE
TOMPKINS COUNTY BOARD OF ELECTIONS
128 E. Buffalo St., Ithaca, NY  14850  (607) 274-5521 or 5522
List of Voters      $.15 page
a. Call List
b. History List
c. Standard List
Labels   $10.00 plus $.015 per voter
a. Standard
b. Household
c. Absentee
 
  Export CD
a. Standard Countywide  $5.00
b. Customized         $10.00

Travel Card   $1.00
Copies               $.25 page
Pollbook          $20.00

    Please add $4.00 Shipping & Handling Charge if you'd like us to mail you your requested information.

Town / Ward / Districts____________________________________________

Party Affiliation
Republican Conservative Green Blank
Democrat Liberal Working Families Other:
Independence Right to Life Libertarian  

Order of Information_____________________________________

Other
Male Active
Female Inactive

Once the information is received by the names(s) below, it is not returnable and no longer property of the Tompkins County Board of Elections.  Payment is non-refundable.
Make checks payable to County of Tompkins.  Payment must be received in advance including completed written information request.

Date: _______________   Phone: _______________

Name:____________________________________
 
Company: ________________________________
 
Street Address: ________________________________
 
City, State, Zip: ________________________________
 
Signature:________________________________

 

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