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Rockland County Board of Elections Voter Registration Information Report for Voter ID
HABER, ADAM M
Address 3 TEMPO ROAD NEW CITY NY 10956-1331
DOB 03/14/1965 Sex M
Status Purge Reason PURGED Town C Ward 000 Clarkstown
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 *
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
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
Apartment Number 151 Village pr my)
O City or Town
Date at Rep. Oinoeilation
Dee 144.84on 1 2 3 4 5
Date of Birth
1k 6 C.
M be t'
Cgw" 4#'113" .
Beeline or Vow
Ve rle riest Number and Street
'City Of Town -I war seas
I State I Name by which Registered
ID Citizen by Birth? IID‘liol.plete Naturalization Papers
I Name by which Issued
IP 7 II 9 10
1:1171000 Other Remarks
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
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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
Print by : tsattie , Printed on : 2/15/2013 10:06:38 AM , ScanDate: 10/9/1992 , BatchNumber : 45 , DocumentNumber : 11