REQUEST FOR REMOVAL OF INFORMATION SURNAME: ___________________________________ GIVEN NAME(S):______________________________ VOTER I.D. NUMBER & STATE (IF SHOWN ON WEBSITE):______________________ VOTER'S ADDRESS AS SHOWN ON WEBSITE: ____________________________________________ ____________________________________________ VOTER'S BIRTH DATE AS SHOWN ON WEBSITE:___________________________ I attest that I am the person whose information appears above, and I hereby ask Tom Alciere to remove information about me from his website pages. __________________________________________ Date_______________20____ Signed and attested before me, a notary public, on this the ________ day of _____________________20_____ __________________________________ My commission expires____________________20______ Don't bother wasting postage if this form is not notarized or if you cannot write the webmaster's name correctly on the envelope. If you are worried about check forgery, sign with your other hand, so it won't match the signature card at the bank. Mail this form to: Tom Alciere, PO Box 106, Nashua NH 03061.