
Poll Watcher/ Observer Name:
Cell Phone:
Polling Site Name and Address:
Election District:
Election Official(s) Involved and Title(s):
Voter Name:
Voter Address:
Voter Phone Number:
Gender: Race/Ethnicity: Age: Other:
Name of Witness(es)
Witness(s) Contact Info
Time of Incident:
Describe Incident:
Posted By: Marta Fernandez
Wednesday, October 22nd 2008 at 3:31PM
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