TRATION. PURSUANT TO TITLE 18 SECTION 116. PLEASE BE ADVISE THAT I AM REQUESTING THE REINSTATEMENT -OF MY REGISTRATION. MY PLACE OF RESIDENCE IS: TQwte s MY MAILING ADDRESS IS: Co I O0 re et i-Lno k Q r)-e v- ) Soto R b lM r. SIGNATURE OF ELECTOR AND DATE FOR OFFICIAL USE ONLY YOUR REQUEST FOR