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MOBILE PHONE NUMBER EMAIL  \nSOCIAL SECURITY NUMBER* (SSN) * \u003CR X P XVW SURY LGH \\R XU 661􀀑 $XWKRULW\\ WR FROOHFW \\R XU 661 LV JUD QWHG E\\ 6HFWLR QV 􀀗􀀜􀀓􀀑􀀖 D QG 􀀘􀀓􀀕 RI WKH 9H KLFOH D QG 7UDIILF /DZ􀀑 7KH LQIRUPDWLR Q Z LOO EH XVHG R QO\\ IR U H[FKDQJH Z LWK RWKHU M XULVGLFWLR QV􀀏 WR DVVLVW LQ YHULILFDWLR Q RILGHQWLW\\􀀏 DQG WR LQYRNH GULYHU OLFHQVH VDQFWLRQV SXUVXDQW WR 9􀀉7 /DZ 6HFWLRQ 􀀘􀀔􀀓􀀋􀀗􀀐H􀀌 DQG 􀀘􀀔􀀓􀀋􀀗􀀐I􀀌􀀑 \u003CRXU QXPEHU ZLOO QRW EH JLYHQ WR  \n        WKH SXEOLF􀀏 RU DSSHDU RQ DQ\\ IRUP RU LQIRUPDWLRQ UHTXHVW􀀑  \nADDRESS WHERE YOU GET YOUR MAIL  \n-Include Street Number and Name, Rural Delivery and/or box number (If PO Box, also fill in “Address Where You Live”below)  \n\n|  | $SW􀀑 1R􀀑 | &LW\\ RU 7RZQ | 6WDWH |  | =LS &RGH | &RXQW\\ |\n| --- | --- | --- | --- | --- | --- | --- |\n\nADDRESS WHERE YOU LIVE REQUIRED IF DIFFERENT FROM ADDRESS FOR MAIL-DO NOT GIVE P. O. BOX. THIS ADDRESS WILL APPEAR ON YOUR DRIVER LICENSE.  \n\n|  | $SW􀀑 1R􀀑 | &LW\\ RU 7RZQ | 6WDWH |  | =LS &RGH | &RXQW\\ |\n| --- | --- | --- | --- | --- | --- | --- |\n\nHAS YOUR MAILING ADDRESS CHANGED? \u003CHV  1R HAS THE ADDRESS WHERE YOU LIVE CHANGED? \u003CHV 1R  \n,I \\RX DQVZHUHG \\HV WR HLWKHU RI WKH TXHVWLRQV DERYH􀀏 WKHQ DGGUHVVHV RQ DOO YHKLFOH UHJLVWUDWLRQV WLHG WR \\RXU ,' QXPEHU ZLOO DOVR EH XSGDWHG ZLWK WKLV DGGUHVV􀀏 XQOHVV \\RXFKHFN WKLV ER[􀀑 ,I \\RX DUH UHJLVWHUHG WR YRWH􀀏 \\RXU YRWHU UHJLVWUDWLRQ UHFRUG ZLOO EH XSGDWHG ZKHQ \\RX FRPSOHWH DQG VXEPLW WKLV IRUP􀀑 ,I \\RX GR 127 ZDQW \\RXU QHZ DGGUHVVRQ \\RXU YRWHU UHJLVWUDWLRQ UHFRUG􀀏 FKHFN WKLV ER[􀀑 ,I \\RX GR QRW FKHFN WKH ER[􀀏 \\RXU QHZ DGGUHVV ZLOO EH VHQW WR WKH %RDUG RI (OHFWLRQV RI \\RXU FRXQW\\ RI UHVLGHQFH􀀑  \nOTHER CHANGE:  \n:KDW LV WKH FKDQJH DQG WKH UHDVRQ IRU LW  \n􀀋QHZ OLFHQVH FODVV􀀏 ZURQJ GDWH RI ELUWK􀀏 HWF􀀑􀀌\"  \n| \u003Cbr>VETERAN STATUS | &KHFN WKLV ER[ LI \\RX ZRXOG OLNH WR KDYH ³9HWHUDQ´ SULQWHG RQ WKH IURQW RI \\RXU SKRWR GRFXPHQW􀀑\u003Cbr>\u003CRX PXVW SUHVHQW SURRI WKDW LQGLFDWHV DQ KRQRUDEOH GLVFKDUJH IURP PLOLWDU\\ VHUYLFH􀀑 )RU DGGLWLRQDO LQIRUPDWLRQ􀀏 SOHDVH VHH IRUP 09􀀐􀀗􀀗􀀑􀀔('/􀀑 |  |\n| --- | --- | --- |\n|  |  |  |\n| NEW YORK STATE ORGAN AND TISSUE DONATION (You must fill out the following section) |  | 􀂆 &KHFNWKLV ER[ WR PDNH D |\n| \u003Cbr>7R HQUROO LQ WKH 1HZ \u003CRUN 6WDWH 'RQDWH/LIH60 5HJLVWU\\􀀏 FKHFN WKH ³\\HV´ ER[ DQG WKHQ VLJQ DQG GDWH EHORZ􀀑 \u003CRX DUH FHUWLI\\LQJ WKDW \\RX DUH􀀝 􀀔􀀙 \\HDUV RIDJH RU ROGHU􀀞 FRQVHQWLQJ WR GRQDWH \\RXU RUJDQV DQG WLVVXHV IRU WUDQVSODQWDWLRQ DQG UHVHDUFK􀀞 DXWKRUL]LQJ '09 WR WUDQVIHU \\RXU QDPH DQG LGHQWLI\\LQJLQIRUPDWLRQ WR WKH 'RQDWH /LIH 5HJ","cbCaiuJSwcae0Ae1","https://ap.wps.com/l/cbCaiuJSwcae0Ae1","pdf",672276,"English","# Office Use Only\n## Identification Information\n## Address and Change Questions\n## Other Change and Veteran Status\n## Organ and Tissue Donation\n## Voter Registration Questions","[{\"question\":\"How should the form be completed and what ink colors are accepted?\",\"answer\":\"Print clearly in blue or black ink.\"},{\"question\":\"What information is required for identification, including a prior name if applicable?\",\"answer\":\"Provide full last name and full name as shown on your identification documents. 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