Payment Voucher

Department of the Secretary of State

Central Voter Registration (CVR) Project

Request for Payment for Data Entry of Voter Records

Unencumbered Contract Number U067806204

Municipality Information (for jurisdiction that performed data entry):

Name of Municipality: ______________________________________

Name of Clerk/Registrar: ____________________________________

Telephone: _______________________________________________

Mailing Address: __________________________________________

___________________________________________

This is a request for payment for services rendered, for manual data entry of voter registration records into the Secretary of State’s interim data entry tool.

We have entered the following number of voter records: _________ for the municipality/ unorganized township of _________________________ at a rate of $0.50 per record, for a total payment due of $______. ___. We understand that payment will be issued upon verification and entry of the records into the ElectioNet™ (CVR) system.

Signature of Municipal Official: ___________________________ Date: ___________

Please submit this request, by mail to:

Bureau of Corporations, Elections and Commissions
ATTN: Andrea Sparrow
101 State House Station
Augusta ME 04330-0101

Or, by FAX to: 287-5428 or 287-6545