ELECTIONS 1449

APPLICATION FOR CERTIFICATE OF REMOVAL.

I, ................... do solemnly swear or affirm that I now reside

at .................. in the City of .................. County of

................... that I am the same person who is entered by that

name as a qualified voter on the registry books of the .................

precinct of the ............. ward or district of ............ City

or County; that I have removed from the said last-mentioned residence,
and I now reside in ............ precinct of the ............ ward or

district of the ............ City or County; that I am entitled to regis-
tration in the voting precinct to which I have removed, and I, therefore,
request that my name be erased from the registry books of the...........

precinct of the ............ ward or district, of the ............ City

or County, and that a certificate of removal be mailed to me at my present
address which is stated above.

Signature of Voter.

State of Maryland, City or County of ............... to wit:

Before me the subscriber, a Notary Public or a Justice of the Peace of
the State of Maryland, in and for the ................ County or city,

personally appeared.......................... the signer of the above

application for a removal certificate, who has been known to me for ......

years, and made oath in due form of law that the matters and facts set
forth in the said application for a removal certificate are true as therein
set forth.

Witness my hand and seal the day and date first above written.

Notary Public or Justice of the Peace.

Upon receipt of every application for a removal certificate as above pro-
vided, it shall be the duty of the Board of Supervisors of Elections, or a
clerk designated by them, to mail to the applicant at his then address as
stated upon his application within not less than ten days from the receipt
of said application, a certificate of removal in substantially the following
form, to wit:

CERTIFICATE OF REMOVAL.

......... Precinct of the ......... Ward or District of the ........

City or County.

This is to certify that the name of ............. heretofore residing

at ................... in the above precinct, has been stricken from the

registry books of the said precinct and the proper erasures have been
made. The following entries appear upon said books with reference to
said voter: Name ............. age ............. color .............

residence ................. nativity ............ time of residence in

precinct ................. time of residence in county or city ..........

time of residence in State .............. naturalization ..............

date of papers........ court ........... qualified voter ...........

date of application ........................

Signature of Board of Supervisors of Elections or
their duly authorized clerk.