Connecticut General Statutes Title 9. Elections § 9-19d. Form of application

The application provided for in section 9-19c shall be in form substantially as follows:

To․․․․ (name), Town Clerk,

of the Town of

       Registrar of Voters,

․․․․, Connecticut,

We the undersigned, being citizens of the United States of voting age, are

[ ]

employed, and all being employees of ․․․․․․․․․․․․․․․․․․ (name of employer)

or

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students attending ․․․․․․․․․․․․․․․․․․․ (name of school, college or university)

or

[ ]

residing at the (name of hospital, residential care home, rest home, nursing home or convalescent home) ․․․․․․․․․․․․․․․․․․․․ in said town and each of us believing that he or she possesses the qualifications for admission as an elector, do hereby request you to come to our place of employment, or school, college or university or residence, as the case may be, at ․․․․․․․․․․․․․․․․․․․․ (address), in said town, for the purpose of receiving applications for admission as an elector.

․․․․ (signatures) ․․․․ (addresses)

Dated at ․․․․, Connecticut, this ․․․․ day of ․․․․, 20․․․