Cherokee Nation Voter Registration Form Return to: Cherokee Nation Election Commission Post Office Box 1188 Tahlequah, OK 74465-1188 (918) 458-5899 * 1-800-353-2895 * Fax: 918-458-6101 * e-mail: [email protected] Must be 18 years of age on or prior to the date of the election to register to vote. If you do not receive a Notice form in 2 weeks, please contact the Election Commission. New Application Change of Affiliation (District or Precinct) Change of Name or Address Other You must have Tribal Citizenship (Blue Card) Name ____________________________________ _______________________________ ___________________________ _______ _______ (Please print) First Middle Last (Jr., Sr., I, II, III) _____________________________ __________________ ________________________________ _M__a_l_e_ _ _____F_e_m__a_le_ _ ___ ___________ _____________ Phone No. Date of Birth Social Security No. (Optional) Sex Maiden ______________________ Mailing Address: ___________________________ ______________________________ ________________________ _________ _____ County of Residency Street, Box, Route Number, Road City State Zip Home Address: ___________________________ ______________________________ ________________________ _________ _____ REQUIRED Street, Box, Route Number, Road City State Zip Driving Directions ___________________________________________________________________________________________________________________________ For Rural Routes or P.O. Box only. Please list directions to your physical address. ________________________________________ _____________________________ _________________________________________________________ ___ ___ Blue Tribal Citizenship Card /Registry # Citizenship Date (Date Approved) Your name as it appears on the Blue Card ___________________________________________________________________________________ ______________________________ ______ _________ ____ Your Handwritten Signature Date Witness, if mark used : 1. _____________________________________________________ 2. _____________________________________________________ ATTENTION NON-RESIDENT VOTERS (CITIZENS NOT LIVING WITHIN THE TRADITIONAL BOUNDARY OF THE CHEROKEE NATION) CHECK HERE FOR AT-LARGE VOTING RESIDENT VOTERS MUST MARK ONE PRECINCT District No. 1 (Cherokee/Wagoner Co) District No. 5 (Muskogee/Sequoyah Co) District No. 8 (Adair Co) District No. 12 Hulbert Redbird Goingsnake (Nowata/Tulsa/Washington/Rogers Co) Cooweescoowee - West Precincts: Precincts: Precincts: Tahlequah Sallisaw Stilwell A. A. A. Precincts: Hulbert Vian Westville Nowata B. B. B. A. Okay Gore Bell Bartlesville C. C. C. B. Skiatook C. District No. 2 (Cherokee Co) District No. 6 (Sequoyah Co) District No. 9 (Delaware/Mayes Co) Tahlequah Sequoyah Saline District No. 13 (Tulsa/Rogers Co) Gadusi Precincts: Precincts: Precincts: Tahlequah Sallisaw Jay A. A. A. Precincts: Lowrey Belfonte Kansas Tulsa B. B. B. A. Briggs Marble City Kenwood Catoosa C. C. C. B. Muldrow Salina Collinsville D. D. C. District No. 3 (Cherokee Co) Tenkiller District No. 7 (Adair Co) District No. 10 (Delaware/Mayes/Ottawa Co) District No. 14 (Rogers/Tulsa Co) Flint Delaware Cooweescoowee - Central Precincts: Tahlequah A. Precincts: Precincts: Precincts: Keys Stilwell Salina Claremore B. A. A. A. Westville Jay Chelsea B. B. B. Cave Springs Grove Oologah District No. 4 (Muskogee/McIntosh Co) C. C. C. Chewey Afton Three Rivers D. D. Spavinaw E. District No. 15 (Mayes/Rogers Co) Precincts: Fort Gibson Pryor A. F. Cooweescoowee - South Warner B. Precincts: Muskogee Claremore C. District No. 11 (Craig/Mayes/Nowata Co) A. Salina Cooweescoowee - North B. Locust Grove Precincts: C. *New applicants age 25 & older who reside outside the South Coffeyville Pryor A. D. Boundaries must register at-large Vinita B. Welch C. *New applicants under the age of 25 who reside outside the Boundaries may select to register at-large or in a district of your choice; but, this selection must be made at the time of your signing of this Voter Registration Form. A copy of your original form will be returned if it is not filled out properly. Call 1-800-353-2895 if there is a question. OFFICE USE ONLY __________________________________ _____________________________ ________________________ _______ _______________________ _____ Received Verified 2nd Received Data Entry.