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, 67 Technology Way, Nashua NH 03060.