02/06/2013 9:46 am

Rockland County Board of Elections Voter Registration Information Report for Voter ID

Page 1

Name

HABER, ADAM M

0504625

Address 3 TEMPO ROAD NEW CITY NY 10956-1331

DOB 03/14/1965 Sex M

Status Purge Reason PURGED Town C Ward 000 Clarkstown

Date 01/01/1987

Reinstated

Phone 638-3262 Reg Date 01/01/1987 Form No Party Republican

Dist 060 District 60 Cong 020 Sen 038 NY 38TH SENATORIAL DISTRICT Asm 092 NO LONGER USED Schl C01 Clarkstown SD Area 1 Vill CLEG 005 5TH Legislative District FD UDD4 Mailing Address Batch No P00019990528 Source Board of Electio Last Converted Entry Action (TEAM) Created 05/28/1999 by * on RCBOE * Last 05/28/1999 by * Modified RCBOE *

Absentee Address

Election Type App Date

Eligible Poll Worker Type Election District Voting History Schl Date

TEAM SQL Version 5.6.3 Copyright NTS Data Services, LLC. User: PIETANZK

r_vtrdp Station: 0023AE57DED0

Board of Elections in the City of New York

FOR OFFICIAL USE ONLY SERIAL NUMBER

51 Last Name ^ House Number Street

First Name

Jr. or Sr.

Aaci"N 0(ciot rzip Code

)12,0 I Sex Height Color of Eyes : ome H TeL MI Len No. gm IrR at tance PeT 'County City and Stale 0". Plena! u41&Ow^ (DO NOT GIVE P.O. BOX NUMBER) Melling Address el afware

141
Apartment Number 151 Village pr my)

5- 9

O City or Town

(oo
^
Date at Rep. Oinoeilation
Dee 144.84on 1 2 3 4 5

Date of Birth

le

1k 6 C.

M be t'

IN

31

Cgw" 4#'113" .

Beeline or Vow

Ve rle riest Number and Street

k22.71 10(-

'City Of Town -I war seas

I State I Name by which Registered

ID Citizen by Birth? IIDliol.plete Naturalization Papers

I Name by which Issued

00000

IP 7 II 9 10

1:1171000 Other Remarks

to

Igr.Yes 0 No Following:

sp.. 8 Fete,'

AFFIDAVIT: affirm that the information provided herein is true PARTY ENROLLMENT be accepted for all and I understand that this application You must enroll In a party to vote in a primary. Check ONE box only in this section. purposes as the equivalent of an affidavit, and If It contains a material false statement, shall subject me to the same penalties for El Conservative Democratic gRepublican perjury as if I had been duly 0 Right to Life 0 Liberal ...V

Tr, `V
,rd u
Democratic Rigida/

ci

fli'51 .frk 7 ..1, i,,,6 ,,_ 1 Scl ' : `-'

' I S V.,-: fli lcitla wel1e ll
MI

13 to l dc ennrOil twish In a party l a5 X 91snabso cr WA al opploard (33r

MN ails Is

a changer snM4Ment (See Instructi o n 13)

YOU MUST ALSO SIGN ON REVVRSE SIDE

wain 10 Mork (Only II axiom

Republican Register Last Name

IV*1,4A 9 16'

E. CS IT 41 ;X

I. Lowe to rap

DO NOT WRITE BELOW THIS UNE Jr.l& Street Address

City or Town

Wd-AD

Print by : tsattie , Printed on : 2/15/2013 10:06:38 AM , ScanDate: 10/9/1992 , BatchNumber : 45 , DocumentNumber : 11