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Kansas Grain Commodity Voter Registration Form

*First Name:

*Last Name:

Middle Name/Initial:

Jr.Sr.II III IV:

*Commodity(ies) Provided:

Corn

Grain Sorghum

Soybeans

Sunflowers

Wheat

*Residence Address:

Apt #:

*City:

*Zip Code:

Mailing Address:
(If different from residence)

*County:

*Date of Birth: