Form Center

2. Town of Natick
   Board of Registrars
   13 E. Central St.
   Natick, MA 01760
   
4. Important:

   General Laws of Massachusetts mandate an annual street listing of residents as of January 1 each year. Update the information provided by adding, deleting, or making changes. Please sign and respond within 10 days, even if no changes are necessary. For assistance, call the Town Clerk, at 508-647-6430, extension 4.

6. Instructions
   • Verify and/or complete all information listed on the form.
   • List all family or household members whose legal address is the same. Include any member of the family in military service, away at school, or confined to a rest home whose legal residence is the same.
   • Make all changes on the shaded line below the printed line.
   • If a new member has been added to the family or household, enter the name and information on the blank line at the end of this form.
   • Put a line through the name of any resident no longer residing at this address and list his/her new address.
   • Moved / Deceased - Check "Moved" or "Deceased" if appropriate.
   • Occupation - Enter occupation - not place of employment.
   • Nationality - Enter only if not a U.S. citizen.
   • Veteran - Check if you are a U.S. veteran.
8. Address
10. Address 2
12. City
13. State
14. ZIP
16. Warning:
    Failure to respond to this form shall result in removal from the active voting list and may result in removal from the voter registration rolls.
20. #1
22. Voter

    Checking indicated a registered voter. You cannot register to vote with this form.

    1. Registered voter
24. Last Name*
25. First Name*
26. Middle Name
28. Mail To

    1. Yes
29. Gender*

    1. Male

    1. Female
31. Date of Birth*
    Date of Birth
32. Occupation
34. Moved / Deceased

    If no longer at the residence, please indicate why.

    1. Moved
    2. Deceased
35. Nationality*
    If not a U.S. citizen
37. Veteran Status

    1. U.S. Veteran
41. Previous Address if at Current Address for Less Than 1 Year
43. Address
45. Address 2
47. City
48. State
49. ZIP
53. #2
55. Voter

    Checking indicated a registered voter. You cannot register to vote with this form.

    1. Registered voter
57. Last Name*
58. First Name*
59. Middle Name
61. Mail To

    1. Yes
62. Gender*

    1. Male

    1. Female
64. Date of Birth*
    Date of Birth
65. Occupation
67. Moved / Deceased

    If no longer at the residence, please indicate why.

    1. Moved
    2. Deceased
68. Nationality*
    If not a U.S. citizen
70. Veteran Status

    1. U.S. Veteran
74. Previous Address if at Current Address for Less Than 1 Year
76. Address
78. Address 2
80. City
81. State
82. ZIP
86. #3
88. Voter

    Checking indicated a registered voter. You cannot register to vote with this form.

    1. Registered voter
90. Last Name*
91. First Name*
92. Middle Name
94. Mail To

    1. Yes
95. Gender*

    1. Male

    1. Female
97. Date of Birth*
    Date of Birth
98. Occupation
100. Moved / Deceased

     If no longer at the residence, please indicate why.

     1. Moved
     2. Deceased
101. Nationality*
     If not a U.S. citizen
103. Veteran Status

     1. U.S. Veteran
107. Previous Address if at Current Address for Less Than 1 Year
109. Address
111. Address 2
113. City
114. State
115. ZIP
119. #4
121. Voter

     Checking indicated a registered voter. You cannot register to vote with this form.

     1. Registered voter
123. Last Name*
124. First Name*
125. Middle Name
127. Mail To

     1. Yes
128. Gender*

     1. Male

     1. Female
130. Date of Birth*
     Date of Birth
131. Occupation
133. Moved / Deceased

     If no longer at the residence, please indicate why.

     1. Moved
     2. Deceased
134. Nationality*
     If not a U.S. citizen
136. Veteran Status

     1. U.S. Veteran
140. Previous Address if at Current Address for Less Than 1 Year
142. Address
144. Address 2
146. City
147. State
148. ZIP
152. #5
154. Voter

     Checking indicated a registered voter. You cannot register to vote with this form.

     1. Registered voter
156. Last Name*
157. First Name*
158. Middle Name
160. Mail To

     1. Yes
161. Gender*

     1. Male

     1. Female
163. Date of Birth*
     Date of Birth
164. Occupation
166. Moved / Deceased

     If no longer at the residence, please indicate why.

     1. Moved
     2. Deceased
167. Nationality*
     If not a U.S. citizen
169. Veteran Status

     1. U.S. Veteran
173. Previous Address if at Current Address for Less Than 1 Year
175. Address
177. Address 2
179. City
180. State
181. ZIP
185. #6
187. Voter

     Checking indicated a registered voter. You cannot register to vote with this form.

     1. Registered voter
189. Last Name*
190. First Name*
191. Middle Name
193. Mail To

     1. Yes
194. Gender*

     1. Male

     1. Female
196. Date of Birth*
     Date of Birth
197. Occupation
199. Moved / Deceased

     If no longer at the residence, please indicate why.

     1. Moved
     2. Deceased
200. Nationality*
     If not a U.S. citizen
202. Veteran Status

     1. U.S. Veteran
206. Previous Address if at Current Address for Less Than 1 Year
208. Address
210. Address 2
212. City
213. State
214. ZIP
218. #7
220. Voter

     Checking indicated a registered voter. You cannot register to vote with this form.

     1. Registered voter
222. Last Name*
223. First Name*
224. Middle Name
226. Mail To

     1. Yes
227. Gender*

     1. Male

     1. Female
229. Date of Birth*
     Date of Birth
230. Occupation
232. Moved / Deceased

     If no longer at the residence, please indicate why.

     1. Moved
     2. Deceased
233. Nationality*
     If not a U.S. citizen
235. Veteran Status

     1. U.S. Veteran
239. Previous Address if at Current Address for Less Than 1 Year
241. Address
243. Address 2
245. City
246. State
247. ZIP
251. #8
253. Voter

     Checking indicated a registered voter. You cannot register to vote with this form.

     1. Registered voter
255. Last Name*
256. First Name*
257. Middle Name
259. Mail To

     1. Yes
260. Gender*

     1. Male

     1. Female
262. Date of Birth*
     Date of Birth
263. Occupation
265. Moved / Deceased

     If no longer at the residence, please indicate why.

     1. Moved
     2. Deceased
266. Nationality*
     If not a U.S. citizen
268. Veteran Status

     1. U.S. Veteran
272. Previous Address if at Current Address for Less Than 1 Year
274. Address
276. Address 2
278. City
279. State
280. ZIP
284. #9
286. Voter

     Checking indicated a registered voter. You cannot register to vote with this form.

     1. Registered voter
288. Last Name*
289. First Name*
290. Middle Name
292. Mail To

     1. Yes
293. Gender*

     1. Male

     1. Female
295. Date of Birth*
     Date of Birth
296. Occupation
298. Moved / Deceased

     If no longer at the residence, please indicate why.

     1. Moved
     2. Deceased
299. Nationality*
     If not a U.S. citizen
301. Veteran Status

     1. U.S. Veteran
305. Previous Address if at Current Address for Less Than 1 Year
307. Address
309. Address 2
311. City
312. State
313. ZIP
317. #10
319. Voter

     Checking indicated a registered voter. You cannot register to vote with this form.

     1. Registered voter
321. Last Name*
322. First Name*
323. Middle Name
325. Mail To

     1. Yes
326. Gender*

     1. Male

     1. Female
328. Date of Birth*
     Date of Birth
329. Occupation
331. Moved / Deceased

     If no longer at the residence, please indicate why.

     1. Moved
     2. Deceased
332. Nationality*
     If not a U.S. citizen
334. Veteran Status

     1. U.S. Veteran
338. Previous Address if at Current Address for Less Than 1 Year
340. Address
342. Address 2
344. City
345. State
346. ZIP
350. #11
352. Voter

     Checking indicated a registered voter. You cannot register to vote with this form.

     1. Registered voter
354. Last Name*
355. First Name*
356. Middle Name
358. Mail To

     1. Yes
359. Gender*

     1. Male

     1. Female
361. Date of Birth*
     Date of Birth
362. Occupation
364. Moved / Deceased

     If no longer at the residence, please indicate why.

     1. Moved
     2. Deceased
365. Nationality*
     If not a U.S. citizen
367. Veteran Status

     1. U.S. Veteran
371. Previous Address if at Current Address for Less Than 1 Year
373. Address
375. Address 2
377. City
378. State
379. ZIP
383. #12
385. Voter

     Checking indicated a registered voter. You cannot register to vote with this form.

     1. Registered voter
387. Last Name*
388. First Name*
389. Middle Name
391. Mail To

     1. Yes
392. Gender*

     1. Male

     1. Female
394. Date of Birth*
     Date of Birth
395. Occupation
397. Moved / Deceased

     If no longer at the residence, please indicate why.

     1. Moved
     2. Deceased
398. Nationality*
     If not a U.S. citizen
400. Veteran Status

     1. U.S. Veteran
404. Previous Address if at Current Address for Less Than 1 Year
406. Address
408. Address 2
410. City
411. State
412. ZIP
416. Number of Dog Licenses:*
     Dog licenses are due by March 1, 2014.
418. Signature of Respondent*
     Digitally signed under penalties of perjury as prescribed by M.G.L. 56, §4.
419. Date*
     Date
421. Telephone Number*
Leave This Blank:


422. Print Only

* indicates a required field