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Name

First Name

Last Name

Email

Phone

Location

County

State / Province

Issue Type *

History says already votedWrong name on registration Party change without consent Deceased family on rollStatus change or removed (marked active, inactive, cancelled, etc)Still on an old voter roll Mail ballot "requested/received" without initiation Bug/website issueOther

Leave blank or mark High Priority according to script details.

High Priority

Description and Time of Incident *

Testimony Permission

Select an optionYes - anonymous Yes - first name and state No

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