HomeMy WebLinkAbout1874.01. - Bomberber, H. C.r
No. 4.
Form of Affidavit to be made by ✓V'ative Born Citizen not Registered, and »rho claims right to rote on age, wide,'
fourth section of Registry Lan', approved /7th of April, /869.
COMMONWE LTH OF PENNSYLVANIA,
COUNTY OF l t {f
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I, [ /3
:�.:�:.�: yf1/ being duly sworn, say : That I am a native born citizen
of the United States; that I am at this da etween the ages of twenty-one and twenty-two years; that I have resided
in the State of Pennsylvania for one year last past, and in this election district where I now claim the right to vote
** 's next preceeding this election.
Sworn and subscribed this (, L .t/
of ( t 187E/, before me.
• •
,; /
N. B.—If'ke person claiming the right to vote on age was born elsewhere than in the United States, he shall, in addition, state that fact in his
affidavit, and shdll produce evidence to t4 election board that he bas been naturalized, or that he is entitled to citizenship by reason of his father's
naturalization. 41 t
day
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At 6,