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* 1. Full Name:

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* 2. Full Address:

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* 3. Telephone Number:

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* 4. Email address:

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* 5. Are you satisfied with the polling place you currently vote at?

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* 6. Do you have any comments or suggestions about where you currently vote?

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* 7. Do you have any comments or suggestions about your polling district?

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* 8. Do you have any comments or suggestions on any other polling places or polling districts in the borough?

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* 9. General comments:

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