Request For Public Information Form: List For Candidates

Document Overview

This is a blank form from the Blair County Voter Registration Office used to request public information regarding candidates. It is designed for individuals seeking voter lists (Street List or Walking List) to support political activities.

Form Requirements

To complete this request, the applicant must provide the following information:

• Date: The date of the request.
• Candidate Details: The name of the candidate and the specific office they are seeking.
• List Type: Selection between a "Street List" or a "Walking List. "
• Party Affiliation: Selection of "Republican," "Democratic," or "All Voters. "
• District: The specific geographic area requested (e. g. , County, City, Borough, Township, MDJ District, Ward, or Precinct).

Affirmation and Legal Compliance

The form includes a mandatory Affirmation section where the requestor must verify that:

• The information will not be used for purposes unrelated to elections, political activities, or law enforcement (per 25 Pa. C. S. §1404(b)(3)).
• The material will not be used for commercial or improper purposes (per 25 Pa. C. S. §1207(b)).
• The material will not be published on the Internet (per 4 Pa. Code §183. 14(k)).
• The requestor understands that false statements are subject to penalties for unsworn falsification to authorities (18 Pa. C. S. §4909).

Requestor Information

The bottom section requires the requestor to provide:

• Printed Name and Signature.
• Street Address, City, State, and Zip Code.
• Telephone Number.

Identification

The requestor must provide identification by checking one of the following boxes and providing the corresponding number:

• PA Driver’s License/ID Card.
• Employee Photo ID (including Name of Employer).
• Other Photo ID.