Jefferson County Clerk's Office
Bobbie Holsclaw
[pic]
JEFFERSON COUNTY CLERK
ELECTION CENTER SERVICES
|701 W. Ormsby Avenue, Suite 301 |(502) |574-610|
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|Louisville, KY 40203 |Fax: (502) |574-501|
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|Name __________________________________ | | | | | |Date ____________________________ |
| | | | |
|Remit to: |Jefferson County Clerk’s Office Election Center | | |
| | |Form of Payment |Cash/Check |
| |701 W. Ormsby Avenue, Suite 301 |Amt Received |__________ |
| |Louisville, KY 40203 | | |
| | | | |
| |Attention: Stephanie Campbell |Total Purchased |__________ |
| | | | |
| | |Change Provided |__________ |
| | |Asst. Clerk |__________ |
| | | | |
|3.23.2017 | Customer Service/Service Forms | | |
| | | |5 |
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