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 ____________________________ |

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|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 | | |

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| |Attention: Stephanie Campbell |Total Purchased |__________ |

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| | |Change Provided |__________ |

| | |Asst. Clerk |__________ |

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|3.23.2017 | Customer Service/Service Forms | | |

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