Newsletter., January 01, 1981, Image 19

APPLICATION FORM FOR ABSENTEE BALLOT
I, ________________________________________ , am an enrolled member of the Confederated
(please print name)
Tribes of Siletz Indians, 18 years of age or older and wish to have an ABSENTEE BALLOT
sent to me at the following address:
Address
Street, P. 0. Box, Apartment, Space, etc.
City
State
Zipcode
Requests by mail should be sent to the address below as soon as possible:
Confederated Tribes of Siletz
Attention: Election Board
P. 0. Box 549
Siletz, Oregon 97380
Signature
Date