B. DO NOT INCLUDE:

Further information on the register and the supplement to the register is available on the "Register of Electors" information leaflet at www.housing.gov.ie

E. FURTHER INFORMATION

D. TWO VERSIONS OF THE REGISTER

The edited register contains the names and addresses of persons whose details can beused for a purpose other than an electoralor other statutory purpose e.g. for directmarketing use by a commercial or other organisation.

EDITED REGISTER

Registration authorities are required to publish two versions of the register: (a) the full register; and (b) the edited register.The full register lists everyone who is entitled to vote and can only be used for an electoral or other statutory purpose.

While every resident is entitled to beregistered, the registration authority (yourcity, county or city and county councils)needs to know a person's citizenship to determine the elections at which they may vote.

The right to vote is as follows:

Irish citizens may vote at every election and referendum; British citizens mayvote at Dáil, European and local elections;EU citizens (other than Irish and British citizens)may vote at European and local elections;Non-EU citizens may vote at local elections.

- A visitor staying temporarily at your address.

- Every person over 18 living at your address;- Any 17 year olds who will be 18 by 15 February next;- Any eligible person who normally lives at your address but is temporarily away;- The name and previous address of anyone listed over who has taken up residence in the past 2 years.

C. CITIZENSHIP

A. BE SURE TO INCLUDE:

Next year's Register of Electors is now being compiled. To ensure that you and members of your household will be registered, complete and return this formIMMEDIATELY.

lf any member of the household wantstheir details to be included on theedited register, you should tick the INoption box in column (v) at part 3 ofthe form, otherwise tick OUT. If these boxesare left blank it will be assumed to be an OUT option. i.e that person will not appear on the edited register.

(please read all notes, use BLOCK CAPITAL letters and a ballpoint pen)

DateDaytime/Mobile Phone Number /E-MailSignature

5. Declaration: I believe that the information given above is correct. It is an offence to fail to give the registration authority any information required for the purpose of its duties or to give false information.

4. Name(s) and any previous address(es) over the past 2 years:

(See Note D)

(See Note D)

IN OUT D D M M Y Y

EIRCODE:

3. In the table below list every person aged 18 years or over, or those who will reach 18 years by 15 February next, and who are ordinarily resident at the address at 1 across. Give required details in relation to each person.

If any of the persons listed wishes to be included in the edited register, tick the IN option box for that person. The person completing this form should check the wishes of each household member (see note D).

1. Full postal address of household: 2. Are there any other households / apartments contained at 1 across?

Option