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Voter Vault Local Access Request
Information on individual for whom access is being requested:
Street Address: _________________________________________________________________
Home Phone:___________________________ Work Phone: ____________________________
Is this individual a PCO? _______ If yes, for which precinct? ____________________________
I am requesting access for this individual for the Voter Vault encompassing: (choose one)
__________ Legislative Dist.
I, __________________________, chair of the ________________________ County
Republican Party, attest that the information provided above is true; that I understand WSRP
reserves the right to deny or retract Voter Vault access to these and any individuals without
notice; and, that it is my responsibility to ensure the security of the Voter Vault and prevent its
abuse by the individual for whom I have requested access.
(WSRP Chairman or Executive Director)
Please return this document to WSRP at:
2840 Northup Way, Suite 140, Bellevue, WA 98004
or via fax at (425) 460-0571