Federal Voter Registration Form 1209 En9242012

8/14/2019 Federal Voter Registration Form 1209 En9242012

1/25

Register To Vote In Your State

By Using This

Postcard Form and Guide

For U.S. Citizens


2/25

General Instructions

Who Can Use this ApplicationIf you are a U.S. citizen who lives or has an addresswithin the United States, you can use the application inthis booklet to:

Register to vote in your State,Report a change of name to your voter registration

office,Report a change of address to your voterregistration oce, orRegister with a political party.

ExceptionsPlease do not use this application if you live outsidethe United States and its territories and have no home(legal) address in this country, orif you are in themilitary stationed away from home. Use the FederalPostcard Application available to you from militarybases, American embassies, or consular oces.

New Hampshiretown and city clerks will accept thisapplication only as a request for their own absenteevoter mailin registration form.North Dakotadoes not have voter registration.Wyominglaw does not permit mail registration.

How to Find Out If You Are Eligible to Register toVote in Your StateEach State has its own laws about who may register andvote. Check the information under your State in theState Instructions. All States require that you be a UnitedStates citizen by birth or naturalization to register to votein federal and State elections. Federal law makes it illegalto falsely claim U.S. citizenship to register to vote in anyfederal, State, or local election. You cannotbe registeredto vote in more than one place at a time.

How to Fill Out this ApplicationUse both the Application Instructions and StateInstructions to guide you in lling out the application.

First, read the Application Instructions. eseinstructions will give you important informationthat applies to everyone using this application.Next, nd your State under the State Instructions.Use these instructions to ll out Boxes 6, 7, and 8.

Also refer to these instructions for information aboutvoter eligibility and any oath required for Box 9.

When to Register to VoteEach State has its own deadline for registering to vote.Check the deadline for your State on the last page ofthis booklet.

How to Submit Your ApplicationMail your application to the address listed underyour State in the State Instructions. Or, deliver theapplication in person to your local voter registrationoce. e States that are required to accept thenational form will accept copies of the applicationprinted from the computer image on regular paperstock, signed by the applicant, and mailed in anenvelope with the correct postage.

First Time Voters Who Register by MailIf you are registering to vote for the rst time inyour jurisdiction and are mailing this registrationapplication, Federal law requires you to show proofof identication the rst time you vote. Proof ofidentication includes:

A current and valid photo identication orA current utility bill, bank statement, governmentcheck, paycheck or government document that

shows your name and address.Voters may be exempt from this requirement if theysubmit a COPYof this identication with their mail invoter registration form. If you wish to submit a COPY,please keep the following in mind:

Your state may have additional identicationrequirements which may mandate you showidentication at the polling place even if you meetthe Federal proof of identication.Do not submit original documents with thisapplication, only COPIES.

If You Were Given this Application in a StateAgency or Public OfficeIf you have been given this application in a Stateagency or public oce, it is your choice to use theapplication. If you decide to use this application toregister to vote, you can ll it out and leave it withthe State agency or public oce. e applicationwill be submitted for you. Or, you can take it withyou to mail to the address listed under your Statein the State Instructions. You also may take itwith you to deliver in person to your local voter

registration oce.Note: e name and location of the State agencyor public office where you received the applicationwill remain condential. It will not appear on yourapplication. Also, if you decide not to use thisapplication to register to vote, that decision willremain condential. It will not aect the service youreceive from the agency or oce.

Revised 03/01/2001


3/25

Application Instructions

Before lling out the body of the form, please answer the questions on the top of the form as to whether you are aUnited States citizen and whether you will be 18 years old on or before Election Day. If you answer no to either of thesequestions, you may not use this form to register to vote. However, state specic instructions may provide additionalinformation on eligibility to register to vote prior to age 18.

Box 1 Name

Put in this box your full name in this order Last,First, Middle. Do not use nicknames or initials.Note:If this application is for a change of name, pleasetell us in Box A(on the bottom half of the form)yourfull name before you changed it.

Box 2 Home AddressPut in this box your home address (legal address). Donotput your mailing address here if it is dierent fromyour home address. Do notuse a post oce box orrural route without a box number. Refer to statespecicinstructions for rules regarding use of route numbers.

Note:If you were registered before butthis is the rsttime you are registering from the address in Box 2,please tell us in Box B(on the bottom half of the form)the address where you were registered before. Pleasegive us as much of the address as you can remember.

Also Note:If you live in a rural area but do not have astreet address, orif you have no address, please showwhere you live using the map in Box C(at the bottomof the form).

Box 3 Mailing AddressIf you get your mail at an address that is dierent fromthe address in Box 2, put your mailing address in thisbox. If you have no address in Box 2, you mustwrite inBox 3 an address where you can be reached by mail.

Box 4 Date of BirthPut in this box your date of birth in this order Month, Day, Year. Be careful not to use todays date!

Box 5 Telephone NumberMost States ask for your telephone number in casethere are questions about your application. However,you do nothave to ll in this box.

Box 6 ID NumberFederal law requires that states collect from eachregistrant an identication number. You must refer toyour state's specic instructions for item 6 regardinginformation on what number is acceptable for yourstate. If you have neither a drivers license nor a socialsecurity number, please indicate this on the form and anumber will be assigned to you by your state.

Box 7 Choice of Party

In some States, you must register with a party if youwant to take part in that partys primary election,caucus, or convention. To nd out if your State requirethis, see item 7 in the instructions under your State.

If you want to register with a party, print in the box thefull name of the party of your choice.

If you do notwant to register with a party, write noparty or leave the box blank. Do notwrite in the wordindependent if you mean no party, because thismight be confused with the name of a political party inyour State.

Note: If you do not register with a party, you can stillvote in general elections and nonpartisan (nonparty)primary elections.

Box 8 Race or Ethnic GroupA few States ask for your race or ethnic group, in orderto administer the Federal Voting Rights Act. To ndout if your State asks for this information, see item 8in the instructions under your State. If so, put in Box 8the choice that best describes you from the list below:

American Indian orAlaskan NativeAsian or Pacic Islander

Black, not of Hispanic OriginHispanicMultiracialWhite, not ofHispanic OriginOther

Box 9 SignatureReview the information in item 9 in the instructionsunder your State. Before you sign or make your mark,make sure that:

(1) You meet your States requirements, and(2) You understand allof Box 9.

Finally, sign your fullname or make your mark, andprint todays date in this order Month, Day, Year.If the applicant is unable to sign, put in Box Dthename, address, and telephone number (optional) of theperson who helped the applicant.

2Revised 03/01/200


4/25

Voter Registration ApplicationBefore completing this form, review the General, Application, and State specific instructions.

Are you a citizen of the United States of America? Yes No

Will you be 18 years old on or before election day? Yes NoIf you checked "No" in response to either of these questions, do not complete form.(Please see state-specific instructions for rules regarding eligibility to register prior to age 18.)

This space for office use only.

1Mr.

Mrs.

Miss

Ms.

Last Name First Name Middle Name(s) Jr

Sr

II

III

IV

2 Home Address Apt. or Lot # City/Town State Zip Code

3Address Where You Get Your Mail If Different From Above City/Town State Zip Code

4

Date of Birth

Month Day Year

5

Telephone Number (optional)

6

ID Number - (See item 6 in the instructions for your state)

7Choice of Party(see item 7 in the instructions for your State) 8

Race or Ethnic Group(see item 8 in the instructions for your State)

9

I have reviewed my state's instructions and I swear/affirm that:I am a United States citizen

I meet the eligibility requirements of my state andsubscribe to any oath required.

The information I have provided is true to the best of myknowledge under penalty of perjury. If I have provided falseinformation, I may be fined, imprisoned, or (if not a U.S.citizen) deported from or refused entry to the United States.

Please sign full name (or put mark)

Date:

Month Day Year

If you are registering to vote for the first time: please refer to the application instructions for information on submittingcopies of valid identification documents with this form.

Please fill out the sections below if they apply to you.

If this application is for a change of name, what was your name before you changed it?

AMr.

Mrs.

Miss

Ms.


Sr

II

III

IV

If you were registered before but this is the first time you are registering from the address in Box 2 , what was your address where you were registered before?

BStreet (or route and box number) Apt. or Lot # City/Town/County State Zip Code

If you live in a rural area but do not have a street number, or if you have no address, please show on the map where you live.

C

Write in the names of the crossroads (or streets) nearest to where you live.

Draw an X to show where you live.

Use a dot to show any schools, churches, stores, or other landmarksnear where you live, and write the name of the landmark.

Example

Woodchuck RoadRoute

#2

Public School

Grocery Store

X

NORTH

If the applicant is unable to sign, who helped the applicant fill out this application? Give name, address and phone number (phone number optional).

D

Mail this application to the address provided for your State.


5/25

FOR OFFICIAL USE ONLY

FIRST CLASS

STAMP

NECESSARY

FORMAILING

Print Applicatio


6/25

Voter Registration ApplicationBefore completing this form, review the General, Application, and State specic instructions.

Are you a citizen of the United States of America? Yes No

Will you be 18 years old on or before election day? Yes NoIf you checked "No" in response to either of these questions, do not complete form.(Please see state-specic instructions for rules regarding eligibility to register prior to age 18.)

This space for office use only.

1Mr.

Mrs.

Miss

Ms.


Sr

IIIIIIV

2 Home Address Apt. or Lot # City/Town State Zip Code

3Address Where You Get Your Mail If Different From Above City/Town State Zip Code

4

Date of Birth

Month Day Year

5

Telephone Number (optional)

6

ID Number - (See item 6 in t he instructions for your state)

7 8Race or Ethnic Group(see item 8 in the instructions for your State)

9

I have reviewed my state's instructions and I swear/affirm that:I am a United States citizen

I meet the eligibility requirements of my state andsubscribe to any oath required.

The information I have provided is true to the best of myknowledge under penalty of perjury. If I have provided falseinformation, I may be ned, imprisoned, or (if not a U.S.citizen) deported from or refused entry to the United States.

Please sign full name (or put mark)

Date:

Month Day Year

If you are registering to vote for the rst time: please refer to the application instructions for information on submittingcopies of valid identication documents with this form.

Please ll out the sections below if they apply to you.

If this application is for a change of name, what was your name before you changed it?

AMr.

Mrs.

Miss

Ms.


Sr

IIIIIIV

If you were registered before but this is the rst time you are registering from the address in Box 2 , what was your address where you were registered before?

BStreet (or route and box number) Apt. or Lot # City/Town/County State Zip Code

If you live in a rural area but do not have a street number, or if you have no address, please show on the map where you live.

C

Write in the names of the crossroads (or streets) nearest to where you live.

Draw an X to show where you live.

Use a dot to show any schools, churches, stores, or other landmarksnear where you live, and write the name of the landmark.

Example

Woodchuck RoadRoute

#2

Public School

Grocery Store

X

NORTH

If the applicant is unable to sign, who helped the applicant ll out this application? Give name, address and phone number (phone number optional).

D

Mail this application to the address provided for your State.

Choice of Party(see item 7 in the instructions for your State)


7/25

FOR OFFICIAL USE ONLY

FIRST CLASS

STAMP

NECESSARY

FORMAILING


8/25

State Instructions

Alabama

Updated: 03-01-2006

Registration Deadline Voterregistrationisclosedduringthetendaysprecedinganelection.Applicationsmustbepostmarkedor delivered by the eleventh dayprior to the election.

6. ID Number. Your social securitynumberisrequested(byauthorityoftheAlabamaSupremeCourt,174122).7. Choice of Party.Optional: Youdonothavetoregisterwithapartyif you want to take part in thatpartysprimaryelection,caucus,or convention.8. Race or Ethnic Group. Youarerequiredtollinthisbox;however, your application willnot be rejected if you fail to do so.See the list of choices under theApplicationInstructionsforBox8(onpage2).9. Signature. ToregisterinAlabama

you

must:

beacitizenoftheUnitedStatesbearesidentofAlabama

andyourcountyatthetimeofregistration

be18yearsoldbeforeanyelectionnothavebeenconvictedofafelony

punishablebyimprisonmentinthepenitentiary (or have had your civilandpoliticalrightsrestored)

notcurrentlybedeclaredmentallyincompetentthroughacompetencyhearing

swearorarmtosupportanddefend the Constitution of theU.S.andtheStateofAlabamaand further disavow any belief oraliationwithanygroupwhichadvocates the overthrow of thegovernmentsoftheU.S.ortheStateofAlabamabyunlawfulmeans

andthattheinformationcontainedhereinistrue,sohelpmeGod

Mailing address:Office of the Secretary of StateP.O.Box5616Montgomery,AL361035616

Alaska

Updated: 03-01-2006

Registration Deadline 30 daysbefore the election.

6. ID Number. Youmustprovideoneofthefollowingidenticationnumbers;AlaskaDriver'sLicenseorAlaskaStateIdenticationCardNumber.IfyoudonothaveanAlaskaDriver'sLicenseorAlaskaStateIdenticationCard,youmustprovidethelastfourdigitsofyourSocialSecurityNumber.Ifyoudonothaveanyoftheseidenticationnumbers,pleasewrite"NONE"ontheform.Auniqueidentifyingnumberwillbeassignedtoyouforvoterregistrationpurposes.isinformationiskeptcondential.Havingthisinformationassistsinmaintainingyourvoterrecordandmayassistinverifyingyouridentity(Title15oftheAlaskaStatutes).7. Choice of Party. You do nothave to declare a party affiliationwhenregisteringtovote.Ifyoudo not choose a party, you will

beregistered

as

Undeclared.

Alaskahasaclosedprimaryelectionsystem.Eachrecognizedpolitical party has a separate ballotlistingonlycandidatesfromthatpoliticalparty.Votersregisteredasamemberofapoliticalpartymayonlyvotethatparty'sballot.Votersregisteredasundeclaredornonpartisanmaychooseone

ballotfromtheballotsavailable.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinAlaskayoumust:

beacitizenoftheUnitedStatesbeatleast18yearsoldwithin90daysofcompletingthisregistrationbearesidentofAlaskanotbeaconvictedfelon(unless

unconditionallydischarged)notberegisteredtovotein

another State

Mailing address:DivisionofElectionsState of Alaska

POBox

110017

Juneau,AK998110017

Arizona

Updated: 03-01-2006

Registration Deadline 29daysbefore the election.

6. ID Number. YourcompletedvoterregistrationformmustcontainthenumberofyourArizona driver license, ornonoperatingidenticationlicense issued pursuant to A.R.S.283165,ifthelicenseiscurrentand valid. If you do not havea current and valid Arizonadriverlicenseornonoperatingidenticationlicense,youmustincludethelastfourdigitsofyour

social

security

number

if

one has been issued to you. If youdo not have a current and validdriverlicenseornonoperatingidenticationlicenseorasocialsecuritynumber,pleasewriteNONEontheform.AuniqueidentifyingnumberwillbeassignedbytheSecretaryofState.

3


9/25

State Instructions

7. Choice of Party. If you areregisteredinapoliticalpartywhichhasqualiedforballotrecognition,youwillbepermittedtovotetheprimaryelectionballotforthatparty.Ifyouareregisteredasanindependent, no party preferenceorasamemberofapartywhichisnotqualiedforballotrecognition,youmayselectandvoteoneprimaryelectionballotforoneoftherecognizedpoliticalparties.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinArizonayoumust:

beacitizenoftheUnitedStatesbe

aresident

of

Arizona

and

your

countyatleast29daysprecedingthenextelection

be18yearsoldonorbeforethenextgeneralelection

nothavebeenconvictedoftreason or a felony (or have hadyourcivilrightsrestored)

notcurrentlybedeclaredanincapacitated person by a courtof law

Mailing address:

Secretary of State/Elections1700W.Washington,7thFloorPhoenix,AZ850072888

Arkansas

Updated: 03-01-2006

Registration Deadline 30 days

before the election.

6. ID Number. Yourcompletedvoterregistrationformmustcontain your state issued driver'slicensenumberornonoperatingidenticationnumber.Ifyoudo not have a driver's license ornonoperatingidentication,youmustincludethelastfourdigits

ofyoursocialsecuritynumber.Ifyou do not have a driver's licenseoranonoperatingidenticationorasocialsecuritynumber,pleasewrite"NONE"ontheform.AuniqueidentifyingnumberwillbeassignedbytheState.7. Choice of Party. Optional. Youdonothavetoregisterwithapartyif you want to take part in thatpartysprimaryelection,caucus,orconvention.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinArkansasyoumust:

beacitizenoftheUnitedStateslive

in

Arkansas

at

the

address

in

Box2ontheapplication

beatleast18yearsoldbeforethenextelection

notbeaconvictedfelon(orhavecompletelydischargedyoursentenceorbeenpardoned)

notclaimtherighttovoteinanyother jurisdiction

notpreviouslybeadjudgedmentallyincompetentbyacourtofcompetentjurisdiction

Mailing address:Secretary of StateVoter ServicesP.O.Box8111LittleRock,AR722038111

California

Updated: 03-01-2006


6. ID Number. Whenyouregistertovote,youmustprovideyourCalifornia drivers license orCaliforniaidenticationcardnumber,ifyouhaveone.Ifyoudo not have a drivers license or

IDcard,youmustprovidethelastfourdigitsofyourSocialSecurityNumber(SSN).Ifyoudonotincludethisinformation,you will be required to provideidenticationwhenyouvote.7. Choice of Party.Please enterthenameofthepoliticalpartywithwhichyouwishtoregister.Ifyoudonotwishtoregisterwithanyparty,enterDeclinetoStateinthe space provided.California law allows voters whodeclinetostateanaliationwithaqualiedpoliticalpartyorwhoaliatewithanonqualiedpoliticapartytovoteintheprimaryelectionof

any

qualied

political

party

that

lesanoticewiththeSecretaryofStateallowingthemtodoso.Youcancall1800345VOTEor visit www.sos.ca.govto learnwhichpoliticalpartiesareallowingnonaffiliated voters to participate intheirprimaryelection.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinCaliforniayoumust:

beacitizenoftheUnitedStatesbearesidentofCaliforniabeatleast18yearsofageatthe

timeofthenextelectionnotbeimprisonedoronparole

for the conviction of a felonynotcurrentlybejudgedmentally

incompetentbyacourtoflawSignatureisrequired.Ifyoumeettherequirementslistedabove,pleasesignanddatetheregistrationcardinthespaceprovided.

Mailing address:Secretary of StateElectionsDivision150011thStreetSacramento,CA95814

4
http://www.sos.ca.gov/http://www.sos.ca.gov/http://www.sos.ca.gov/


10/25

State Instructions

Colorado

Updated: 03-28-2008

Registration Deadline 29days before the election. If the

applicationisreceivedinthemailswithoutapostmark,itmustbereceivedwithin5daysofthecloseofregistration.6. ID Number. Yourcompletedvoterregistrationformmustcontainyour state issued driver's licensenumberoridenticationnumber.If you do not have a driver's licenseorstateissuedidentication,youmustincludethelastfourdigitsofyoursocialsecuritynumber.Ifyou do not have a driver's licenseorastateissuedidenticationorasocialsecuritynumber,pleasewrite"NONE"ontheform.Auniqueidentifyingnumberwillbeassignedby the State.7. Choice of Party. Youmustregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection, caucus, or convention.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinColoradoyoumust:

beacitizenoftheUnitedStatesbearesidentofColorado30days

prior to the electionbe18yearsoldonorbefore

election daynotbeconnedasaprisoner

orservinganypartofasentenceundermandate

Mailing address:Colorado Secretary of State1700Broadway,Suite270Denver,Colorado80290

Connecticut

Updated: 03-01-2006


6. ID Number.ConnecticutDriver'sLicenseNumber,orifnone,thelastfourdigitsofyourSocialSecurityNumber.7. Choice of Party. isisoptional,butyoumustregisterwith a party if you want to takepartinthatpartysprimaryelection, caucus, or convention.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinConnecticutyoumust:

beacitizenoftheUnitedStatesbearesidentofConnecticut

and of the town in which you wishto vote

be17yearsold.Youcanvotewhenyouturn18havecompletedconnementand

parole if previously convicted of a

felony,and

have

had

your

voting

rightsrestoredbyRegistrarsofVoters.notcurrentlybedeclaredmentally

incompetenttovotebyacourtoflaw

Mailing address:Secretary of StateElectionsDivision30 Trinity StreetHartford, CT 06106

DelawareUpdated: 02-07-2012

Registration Deadline e4thSaturdaybeforeaprimaryorgeneralelection,and10daysbefore a special election.

6. ID Number. Yourcompletedvoterregistrationformmustcontain your state issued driver'slicensenumberornonoperatingidenticationnumber.Ifyoudo not have a driver's license or

nonoperatingidentication,youmustincludethelastfourdigitsofyoursocialsecuritynumber.Ifyou do not have a driver's licenseoranonoperatingidenticationorasocialsecuritynumber,pleasewrite"NONE"ontheform.AuniqueidentifyingnumberwillbeassignedbytheState.7. Choice of Party. Youmustregisterwithapartyifyouwanttotake

part

in

that

partys

primary

election, caucus, or convention.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinDelawareyoumust:

beacitizenoftheUnitedStatesbeapermanentresidentof

Delawarebeatleast18yearsoldonthe

dateofthenextgeneralelectionfelonsareeligibletovoteif

certainrequirementsaremet:nesandsentencecompletedatleastveyearspriortoapplicationdate;felonyconvictionscannotbedisqualifyingfelonies,whicharemurder,sexualoenses,orcrimesagainstpublicadministrationinvolvingbriberyorimproperinfluence or abuse of office.

notbementallyincompetent

Mailing address:

StateofDelawareOffice of the State ElectionCommissioner905S.GovernorsAve.,Suite170Dover,DE19904

5


11/25

State Instructions

District of Columbia

Updated: 10-29-2003


6. ID Number. Federallawnowrequiresthatallvoterregistrationapplicationsmustincludeeitherthe applicants drivers licensenumberorthelastfourdigitsof the applicants social securitynumberinordertobeprocessed.7. Choice of Party. Youmustregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection, caucus, or convention.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterintheDistrictofColumbiayoumust:

beacitizenoftheUnitedStatesbeaDistrictofColumbia

residentatleast30daysprecedingthenextelection

beatleast18yearsoldonorprecedingthenextelection

notbe

in

jail

for

afelony

conviction

nothavebeenjudgedmentally

incompetentbyacourtoflawnotclaimtherighttovote

anywhereoutsideD.C.

Mailing address:DistrictofColumbiaBoardofElections & Ethics4414thStreet,NW,Suite250Washington,DC200012745

Florida

Updated: 11-30-2011


6. ID Number. If you have one,youmustprovideyourFlorida

driver'slicensenumberorFloridaidenticationcardnumber.IfyoudonothaveaFloridadriver'slicenseoridenticationcard,youmustprovidethelastfourdigitsofyoursocialsecuritynumber.Ifyouhavenotbeenissuedanyofthesenumbers,youmustwritethewordNONE.7. Choice of Party. Youmustregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection, caucus, or convention.8. Race or Ethnic Group.You arerequested,butnotrequired,tollinthisbox.Seethelistofchoicesunder the Application InstructionsforBox8(onpage2).9. Signature. To

register

in

Florida

youmust:

beacitizenoftheUnitedStatesbealegalresidentofboththe

StateofFloridaandofthecountyinwhichyouseektoberegistered

be18yearsold(youmaypreregisterifyouareatleast16)

notbeadjudicatedmentallyincapacitatedwithrespecttovotinginFloridaoranyotherState,orifyouhave,youmustrsthaveyourvotingrightsrestored.notbeaconvictedfelon,orifyou

are,youmustrsthaveyourcivilrightsrestorediftheyweretakenaway.

swearorarmthefollowing:IwillprotectanddefendtheConstitution of the United Statesand the Constitution of the StateofFlorida,thatIamqualiedtoregisterasanelectorundertheConstitution and laws of the State of

Florida,andthatallinformationinthis application is true.

Mailing address:StateofFloridaDepartmentofStateDivisionofElectionseR.A.GrayBuilding500SouthBronoughSt,Rm316Tallahassee,Florida323990250

Georgia

Updated: 03-28-2008

Registration Deadline ehMondaybeforeanygeneralprimary,generalelection,orpresidentialpreferenceprimary,orregularlyscheduledspecialelectionpursuanttotheGeorgiaElectionCode. In the event that a specialelection is scheduled on a dateother that those dates prescribedbytheGeorgiaElectionCode,registrationwouldcloseonthe5thdayaerthecall.6. ID Number. FederallawrequiresyoutoprovideyourfullGADriversLicensenumberorGAStateissuedIDnumber.IfyoudonothaveaGADriversLicenseorGAIDyoumustprovidethelast4digitsofyourSocialSecuritynumber.ProvidingyourfullSocialSecuritynumberis optional. Your Social Securitynumberwillbekeptcondentialandmaybeusedforcomparisonwith

other

state

agency

databases

forvoterregistrationidenticationpurposes. If you do not possessaGADriversLicenseorSocialSecuritynumber,auniqueidentiewill be provided for you.

7. Choice of Party.You do nothavetoregisterwithapartytotakepartinthatpartysprimary,caucusor convention.8. Race or Ethnic Group.Youarerequestedtollinthisbox.See the list of choices under theApplicationInstructionsforBox8(onpage2).9. Signature. ToregisterinGeorgiayoumust:

beacitizenoftheUnitedStatesbealegalresidentofGeorgiaand

of the county in which you wantto vote

6


12/25

State Instructions

be18yearsoldwithinsixmonthsaerthedayofregistration,andbe18yearsoldtovotenotbeservingasentenceforhavingbeenconvictedofafelonynothavebeenjudiciallydeterminedtobementallyincompetent,unlessthedisabilityhasbeenremoved

Mailing address:ElectionsDivisionOffice of the Secretary of State1104WestTower2MartinLutherKing,Jr.Dr.SEAtlanta,GA303341505

Hawaii

Updated: 03-01-2006


6. ID Number.Your full socialsecuritynumberisrequired.Itis used to prevent fraudulentregistrationandvoting.Failuretofurnishthisinformationwill prevent acceptance of thisapplication (Hawaii RevisedStatutes,Section1115).7. Choice of Party. Achoiceofparty is not required for voterregistration.8. Race or Ethnic Group.Race orethnicgroupinformationisnotrequiredforvoterregistration.9. Signature. ToregisterinHawaiiyou

must:

beacitizenoftheUnitedStatesbearesidentoftheStateof

Hawaiibeatleast16yearsold(youmustbe18yearsoldbyelectiondayinordertovote)

notbeincarceratedforafelonyconvictionnotbeadjudicatedbyacourtasnoncomposmentis

Mailing address:

Office of ElectionsState of Hawaii802LehuaAvenuePearlCity,HI96782

Idaho

Updated: 03-01-2006

Registration Deadline 25daysbefore the election.6. ID Number. Enter your driver'slicensenumber.Ifyouhavenodriver'slicense,enterthelast4digitsofyoursocialsecuritynumber.7. Choice of Party. You do not havetoregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection, caucus, or convention.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinIdahoyoumust:beacitizenoftheUnitedStateshaveresidedinIdahoandinthe

county for 30 days prior to the dayof electionbeatleast18yearsoldnothavebeenconvictedofafelony,andwithouthavingbeenrestoredtotherightsofcitizenship,orconnedinprisononconvictionofacriminaloense

Mailing address:Secretary of StateP.O.Box83720StateCapitolBldg.Boise,ID837200080

Illinois

Updated: 08-14-2012

Registration Deadline 28daysprior to each election.

6. ID Number.Your driverslicensenumberisrequiredtoregistertovote.Ifyoudonothavea drivers license, at least the lastfourdigitsofyoursocialsecuritynumberarerequired.Ifyouhaveneither,pleasewriteNONEontheform.AuniqueidentierwillbeassignedtoyoubytheState.7. Choice of Party. Partyregistrationor preference is not required forvoterregistration.However,whenyouapplyforaprimaryballot,youmustindicateyourpartypreferencefor that election.8. Race or Ethnic Group. Leaveblank.9. Signature. Asignatureisrequired.Ifsignatureismissingfromregistrationform,youwillbenotiedyourregistrationisincomplete.

ToregisterinIllinoisyoumust:beacitizenoftheUnitedStatesbearesidentofIllinoisandof

your election precinct at least 30daysbeforethenextelectionbeatleast18yearsoldonorbeforethenextelectionnotbeinjailforafelony

convictionnotclaimtherighttovote

anywhere else

Mailing address:StateBoardofElections2329S.MacArthurBoulevardSpringeld,IL62704

7


13/25

Indiana

Updated: 03-01-2006


6. ID Number. YourstatevoterIDnumberisyourtendigitIndianaissueddriver'slicensenumber.Ifyoudo not possess an Indiana driver'slicense then provide the last fourdigitsofyoursocialsecuritynumber.Pleaseindicatewhichnumberwasprovided.(IndianaCode371313)7. Choice of Party. Leaveblank.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinIndianayoumust:beacitizenoftheUnitedStates

haveresidedintheprecinctatleast30daysbeforethenextelection

beatleast18yearsofageonthedayofthenextgeneralelection

notcurrentlybeinjailforacriminalconviction

Mailing address:ElectionDivisionOffice of the Secretary of State302WestWashingtonStreet,RoomE204Indianapolis,IN462042743

Iowa

Updated: 03-28-2008

Registration Deadline Must bedeliveredby5p.m.10daysbeforetheelection,ifitisastateprimaryorgeneralelection;11daysbeforeallothers.*Registrationformswhicharepostmarked15ormoredaysbeforeanelectionareconsideredontimeevenifreceivedaerthedeadline.

*Ifyoufailtomeetthevoterregistrationdeadlinesaboveyoucanregisterandvotebyfollowingtheguidelinesforelectiondayregistration.Youcanndtheseon the Iowa Secretary of States

website: www.sos.state.ia.us/pdfs/elections/EDRbrochure.pdf.

State Instructions

6. ID Number. YourIDnumberisyourIowadriver'slicensenumber(orIowanondriveridenticationnumber)ifyouhaveone,ifnotthenthelastfourdigitsofyoursocialsecuritynumber.eIDnumberyouprovidewillbeveriedwiththeIowaDepartmentof Transportation or the SocialSecurityAdministration.7. Choice of Party. Youmay,butdonothaveto,registerwithapartyin advance if you want to take partinthatpartysprimaryelection.Youmaychangeordeclareapartyaliationatthepollsonprimaryelection day.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinIowayoumust:

beacitizenoftheUnitedStatesbearesidentofIowabeatleast171/2yearsold(you

mustbe18tovote)nothavebeenconvictedofa

felony(orhavehadyourrightsrestored)

notcurrentlybejudgedbyacourttobe"incompetenttovote"

notclaimtherighttovoteinmorethanoneplacegiveupyourrighttovoteinanyother place

Mailing address:ElectionsDivisionOffice of the Secretary of StateLucasBuilding1stFloor321 E. 12th StreetDesMoines,IA50319

Kansas

Updated: 03-01-2006

Registration Deadline Postmarkedordelivered15daysbefore the election.

6. ID Number. Yourcompletedvoterregistrationformmustcontain your state issued driver'slicensenumberornondriver'sidenticationcard number.Ifyoudo not have a driver's license ornondriver's identication card, youmustincludethelastfourdigitsofyoursocialsecuritynumber.Ifyou do not have a driver's licenseor a nondriver's identication cardorsocialsecuritynumber,pleasewrite"NONE"ontheform.Auniqueidentifyingnumberwillbeassigned by the State. enumberyou provide will be used foradministrativepurposesonlyandwill not be disclosed to the public.(KSA252309).7. Choice of Party. Youmustregister

with

aparty

if

you

want

totakepartinthatpartysprimary

election, caucus, or convention.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinKansasyoumust:

beacitizenoftheUnitedStatesbearesidentofKansasbe18bythenextelectionhavecompletedthetermsofyour

sentenceifconvictedofafelony;apersonservingasentenceforafelonyconvictionisineligibletovote

notclaimtherighttovoteinanyother location or under any othername

notbeexcludedfromvotingformentalincompetencebyacourtofcompetentjurisdiction

8
http://www.sos.state.ia.us/pdfs/elections/EDRbrochure.pdfhttp://www.sos.state.ia.us/pdfs/elections/EDRbrochure.pdfhttp://www.sos.state.ia.us/pdfs/elections/EDRbrochure.pdfhttp://www.sos.state.ia.us/pdfs/elections/EDRbrochure.pdfhttp://www.sos.state.ia.us/pdfs/elections/EDRbrochure.pdf


14/25

State Instructions

Mailing address:Secretary of State1stFloor,MemorialHall120SW10thAve.Topeka,KS666121594

Kentucky

Updated: 03-01-2006


6. ID Number. Your full socialsecuritynumberisrequired.Itisusedforadministrativepurposesonly and is not released to the

public(KRS116.155).Nopersonshallbedeniedtherighttoregisterbecause of failure to include socialsecuritynumber.7. Choice of Party. Youmustregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection, caucus, or convention.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinKentuckyyoumust:beacitizenoftheUnitedStatesbearesidentofKentuckybearesidentofthecountyforat

least28dayspriortotheelectiondatebe18yearsofageonorbeforethenextgeneralelectionnotbeaconvictedfelonorifyou

have been convicted of a felony,yourcivilrightsmusthavebeenrestoredbyexecutivepardonnot

have

been

judged

mentally

incompetentinacourtoflawnotclaimtherighttovote

anywhere outside Kentucky

Mailing address:StateBoardofElections140WalnutStreetFrankfort,KY406013240

Louisiana

Updated: 08-14-2012


6. ID Number. YoumustprovideyourLouisianadriverslicensenumberorLouisianaspecialidenticationcardnumber,ifissued. Ifnotissued,youmustprovideatleastthelastfourdigitsofyoursocialsecuritynumber,ifissued.Tefullsocialsecuritynumbermaybeprovidedona

voluntary basis. If the applicant

hasneitheraLouisianadriverslicense,aLouisianaspecialidenticationcard,orasocialsecuritynumber,theapplicantshallattachoneofthefollowingitemstohisapplication:(a)acopy of a current and valid photoidentication;or(b)acopyofacurrentutilitybill,bankstatement,governmentcheck,paycheck,orothergovernmentdocumentthatshows

the

name

and

address

of

applicant.NeithertheregistrarnortheDepartmentofStateshall disclose the social securitynumberofaregisteredvoteror circulate the social securitynumbersofregisteredvotersoncommerciallists(R.S.18:104and154;42U.S.C.405).7. Choice of Party.If you do notlist a party affiliation, you cannotvote in the Presidential PreferencePrimaryandpartycommitteeelections. Political party affiliationis not required for any otherelection.8. Race or Ethnic Group.Youarerequestedtollinthisbox.See the list of choices under theApplicationInstructionsforBox8(onpage2).

9. Signature. ToregisterinLouisianayoumust:beacitizenoftheUnitedStatesbearesidentofLouisiana(Residenceaddressmustbeaddresswhereyouclaimhomesteadexemption,ifany,exceptforaresidentinanursinghomeorveteranshomewhomayselecttousetheaddressofthenursinghomeorveteranshomeorthehomewherehehasahomesteadexemption.Acollegestudentmayelecttousehishomeaddressorhisaddresswhileawayatschool.)beatleast17yearsold,andbe18yearsoldpriortothenextelectionto votenotcurrentlybeunderanorderofimprisonmentforconvictionofa felonynotcurrentlybeundera

judgmentofinterdictionformentalincompetence

Mailing address:Secretary of StateAttention:VoterRegistrationP.O.Box94125BatonRouge,LA708049125

Maine

Updated: 08-14-2012

Registration Deadline Delivered21 business days before the election(oravotermayregisterin-person uptoandincludingelectionday).6. ID Number. Youmustlistyour valid Maine driver's licensenumber.Ifyoudon'thaveavalidMaine driver's license, then youmustprovidethelastfourdigitsofyourSocialSecurityNumber.Voters who don't have either oftheseformsofIDmustwrite"NONE"inthisspace.

9


15/25

State Instructions

7. Choice of Party. Youmustregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection, caucus, or convention(unlessotherwisepermittedbyapoliticalparty).8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinMaineyoumust:

beacitizenoftheUnitedStatesbearesidentofMaineandthe

municipalityinwhichyouwantto vote

beatleast17yearsold(youmustbe18yearsoldtovote)

Mailing address:ElectionsDivisionBureauofCorporations,ElectionsandCommissions101 State House StationAugusta,ME043330101

Maryland

Updated: 06-26-2008

Registration Deadline 9:00p.m.21daysbeforetheelection.6. ID Number. If you have acurrent, valid Maryland driverslicense or a Motor VehicleAdministrationidenticationcard,youmustenterthedriverslicenseoridenticationnumber.Ifyoudonot have a current, valid Marylanddrivers license or Motor VehicleAdministrationidenticationcard,youmustenteratleastthelast4digitsofyoursocialsecuritynumber.However,pleasenote,the disclosure of your full SocialSecuritynumberisvoluntary.estatutoryauthorityallowingelectionofficials to request your full SocialSecuritynumberisElectionLawArticle,Section3202,AnnotatedCodeofMaryland.enumberwill

beusedonlyforregistrationandotheradministrativepurposes.Itwillbekeptcondential.7. Choice of Party. Youmustregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinMarylandyoumust:

beaU.S.citizenbeaMarylandresidentbeatleast18yearsoldbythe

nextgeneralelectionnotbeunderguardianshipfor

mentaldisabilitynot

have

been

convicted

of

buyingorsellingvotes

nothavebeenconvictedofafelony, or if you have, you havecompletedservingacourtorderedsentenceofimprisonment,includinganytermofparoleorprobation for the conviction.

Mailing address:StateBoardofElectionsP.O.Box6486Annapolis,MD214010486

Massachusetts

Updated: 03-01-2006


6. ID Number. Federallawrequiresthat you provide your driverslicensenumbertoregistertovote.If you do not have a current andvalid Massachusetts drivers licensethenyoumustprovidethelastfour(4)digitsofyoursocialsecuritynumber.Ifyouhaveneither,youmustwriteNONEintheboxandauniqueidentifyingnumberwillbeassignedtoyou.

7. Choice of Party.If you donotdesignateapartyofpoliticaldesignationinthisbox,youwillberegisteredasunenrolled.Unenrolledvotersmayparticipateinpartyprimaries.However,anunenrolledvotermustenrollinaparty on the day of the PresidentiaPreferencePrimaryinordertoparticipateinthatprimary.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinMassachusettsyoumust:

beacitizenoftheUnitedStatesbearesidentofMassachusettsbe18yearsoldonorbeforethe

nextelection

nothavebeenconvictedof

corrupt practices in respect toelections

notbeunderguardianshipwithrespecttovoting

notbecurrentlyincarceratedfora felony conviction

Mailing address:SecretaryoftheCommonwealthElectionsDivision,Room1705One Ashburton PlaceBoston,MA02108

Michigan

Updated: 03-01-2006


6. ID Number. Yourcompleted

voterregistrationformmustcontain your state issued driver'slicensenumberorstateissuedpersonalidenticationcardnumber.Ifyoudonothaveadriver's license or state issuedpersonalidenticationcard,youmustincludethelastfourdigitsofyoursocialsecuritynumber.Ifyou

10


16/25

State Instructions

do not have a driver's license or astateissuedpersonalidenticationcardorasocialsecuritynumber,pleasewrite"NONE"ontheform.AuniqueidentifyingnumberwillbeassignedbytheState.7. Choice of Party. A"choiceofparty"isnotrequiredforvoterregistration.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinMichiganyoumust:beacitizenoftheUnitedStatesbe18yearsoldbythenextelection

bearesidentofMichiganandatleast a 30 day resident of your cityor township by election day

notbeconnedinajailaerbeingconvictedandsentenced

Notice: Michiganlawrequiresthatthesameaddressbeusedforvoterregistrationanddriverlicensepurposes.erefore,iftheresidenceaddressyouprovideonthisformdiersfromtheaddressshownon a driver license or personalidenticationcardissuedbytheStateofMichigan,theSecretaryofStatewillautomaticallychangeyour driver license or personalidenticationcardaddresstomatchthe residence address entered onthisform.Ifanaddresschangeismade,theSecretaryofStatewillmailyouanaddressupdatestickerfor your driver license or personalidenticationcard.Caution: Ifyouregisterbymail,youmustvoteinpersonatyourassignedprecinctthersttimeyouvote, unless you are:

disabledasdenedbystatelaw;60yearsofageorolder;ortemporarilyresidingoverseas.

Mailing address:MichiganDepartmentofStateBureauofElectionsP.O.Box20126Lansing,MI489010726

Minnesota

Updated: 12-31-2008

Registration Deadline Deliveredby5:00p.m.21daysbefore the election (there is alsoelectiondayregistrationatpollingplaces).6. ID Number. You are required

to provide your Minnesota driverslicenseorstateIDnumbertoregistertoVote.Ifyoudonothavea Minnesota drivers license or stateIDthenyouwillhavetoprovidethelastfourdigitsofyoursocialsecuritynumber.Ifyouhaveneither,pleasewritenoneontheform.7. Choice of Party. Leaveblank.8. Race or Ethnic Group. Leaveblank.

9. Signature. Toregister

in

Minnesotayoumust:

beacitizenoftheUnitedStatesbearesidentofMinnesotafor20

daysbeforethenextelectionmaintainresidenceattheaddress

givenontheregistrationformbeatleast18yearsoldon

election dayifpreviouslyconvictedofafelony,

yourfelonysentencehasexpiredorbeencompleted,oryouhavebeendischargedfromthesentence

notbeunderacourtorderedguardianshipinwhichtherighttovote has been revoked

notbefoundbyacourttobelegallyincompetenttovote.

Mailing address:Secretary of State60EmpireDrive,Suite100St.Paul,MN551031855

MississippiUpdated: 05-07-2010


6. ID Number. You are requiredto provide your current and validdriver'slicensenumberor,ifyoudonthaveone,thelastfourdigitsofyoursocialsecuritynumber.7. Choice of Party. Mississippidoesnothavepartyregistration.erefore,youdonothavetoregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection, caucus, or convention.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinMississippiyoumust:

beacitizenoftheUnitedStateshave

lived

in

Mississippi

and

in

yourcounty(andcity,ifapplicable30 days before the election inwhich you want to vote

be18yearsoldbythetimeofthegeneralelectioninwhichyouwantto vote

havenotbeenconvictedofmurder,rape,bribery,the,arson,obtainingmoneyorgoodsunderfalsepretense,perjury,forgery,embezzlement,armedrobbery,extortion,felonybadcheck,felonyshopliing,larceny,receivingstolenproperty,robbery,timberlarceny,unlawfultakingofamotorvehicle,statutoryrape,carjacking,orbigamy,orhavehadyourrightsrestored as required by law

nothavebeendeclaredmentallyincompetentbyacourt

11


17/25

State Instructions

Note: Statelawchangedbyfederalcourtorderin1998andbystatelegislationin2000.Wenowaccepttheformasregistrationforvotingfor all state and federal offices.

Mailing address:Secretary of StateP.O.Box136Jackson,MS392050136

Local county addresses:Youalsomayreturncompletedapplications to the county circuitclerk/registrarwhereyoureside.Acompletelistofcountycircuitclerk/registrarsisavailableonMississippis website at www.sos.ms.gov.

Missouri

Updated: 09-12-2006


6. ID Number. Yourcompletedvoterregistrationformmustcontain your state issued driver'slicensenumber.Yourcompletedvoterregistrationformmustalsoincludethelastfourdigitsofyoursocialsecuritynumber.(Section115.155,RSMo).Ifyoudo not have a driver's license orasocialsecuritynumber,pleasewrite"NONE"ontheform.AuniqueidentifyingnumberwillbeassignedbytheState.Anyelectronicmedia,printoutsormailinglabelsprovidedunderthissection shall not include telephonenumbersandsocialsecuritynumbersofvoters.(Section115.157,RSMo).7. Choice of Party. You do not havetoregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection, caucus, or convention.

8. Race or Ethnic Group. Leaveblank.9. Signature. To vote in Missouriyoumust:

beacitizenoftheUnitedStatesbearesidentofMissouribeatleast171/2yearsofage(youmustbe18tovote)notbeonprobationorparole

aerconvictionofafelony,untilnallydischargedfromsuchprobation or parole

notbeconvictedofafelonyormisdemeanorconnectedwiththerightofsurage

notbeadjudgedincapacitatedbyany court of law

notbe

conned

under

asentence

ofimprisonment

Mailing address:Secretary of StateP.O.Box1767JeersonCity,MO651021767

Montana

Updated: 03-01-2006


6. ID Number. Youmustprovideyour Montana driver's licensenumber.Ifyoudo not have aMontanadriver'slicensenumberthenyoumustlisttheLASTFOURDIGITSOFYOURSOCIALSECURITYNUMBER.Ifyouhave neither a driver's license, norasocialsecuritynumber,pleasewriteNONEontheform.estateofMontanawillassigntoyouauniqueidentifyingnumber.7. Choice of Party.Montana doesnotrequirepartyregistrationtoparticipate in any election.8. Race or Ethnic Group. Leaveblank.

9. Signature. ToregisterinMontanayoumust:beacitizenoftheUnitedStatesbeatleast18yearsoldonorbefore the election

bearesidentofMontanaandofthe county in which you want tovote for at least 30 days before thenextelection

notbeinapenalinstitutionforafelony conviction

notcurrentlybedeterminedbyacourttobeofunsoundmind

meetthesequalicationsbythenextelectiondayifyoudonotcurrentlymeetthem

Mailing address:Secretary of States OfficeP.O.Box202801State CapitolHelena,MT596202801

Nebraska

Updated: 03-01-2006

Registration Deadline ethird

Friday

before

the

election

(ordeliveredby6p.m.onthesecondFridaybeforetheelection).6. ID Number. YoumustprovideyourNebraskadriver'slicensenumber. If you do not have aNebraskadriver'slicensenumberthenyoumustlistthelastfourdigitsofyoursocialsecuritynumber.7. Choice of Party. Youmustregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection, caucus, or convention.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinNebraskayoumust:

beacitizenoftheUnitedStatesbearesidentofNebraska

12
http://www.sos.ms.gov/http://www.sos.ms.gov/http://www.sos.ms.gov/http://www.sos.ms.gov/http://www.sos.ms.gov/


18/25

State Instructions

beatleast18yearsofageorwillbe18yearsofageonorbeforetherstTuesdayaertherstMondayofNovember

nothavebeenconvictedofafelony, or if convicted, have had

yourcivilrightsrestorednothavebeenociallyfoundtobementallyincompetent

Mailing address:NebraskaSecretaryofStateSuite2300,StateCapitolBldg.Lincoln,NE685094608

Nevada

Updated: 05-07-2010

Registration Deadline edeadlineformailinregistrationisthehSaturdaybeforeanyprimaryorgeneralelection.Inpersonregistrationremainsavailableuntil9:00p.m.onthethirdTuesdayprecedinganyprimaryorgeneralelection.YoumayregistertovoteinpersononlybyappearingattheoceoftheCountyClerk/RegistrarofVoters.6. ID Number. You mustsupply aNevadasDriversLicenseNumberor Nevada ID Card Number if youhave been issued one. If you do nothaveaDriversLicenseNumberorNevadaIDCardNumber,youmustsupplythelastfourdigitsofyourSocialSecurityNumber.Ifyou do not have a Social Security

Number,pleasecontactyourCountyClerk/RegistrarofVoterstobeassignedauniqueidentier.7. Choice of Party. Youmustregisterwithapartyifyouwant to take part in that partysprimaryelection,caucus,orconvention.Ifyouregisterwithaminorpoliticalparty,orasaNonpartisanyouwillreceive

aNonpartisanBallotforthePrimaryElection.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinNevadayoumust:

beacitizenoftheUnitedStateshaveattainedtheageof18yearsonthedateofthenextelection

havecontinuouslyresidedintheStateofNevada,inyourcounty,atleast 30 days and in your precinctatleast10daysbeforethenextelection

haveyourcivilrightsrestoredifyou were convicted of a felony

notbedeterminedbyacourtoflaw

to

be

mentally

incompetent

claimnootherplaceasyourlegal

residence

Mailing address:Secretary of StateElectionsDivision101NorthCarsonStreetSuite 3CarsonCity,NV897014786

Applicationsmaybereturnedtothe Secretary of States office atthe address above, but to avoidpossible delays, you are advisedtoreturnyourcompletedvoterregistrationapplicationsdirectlytoyour local county election official.

Local county addresses:Tomeetregistrationdeadlines,especiallyduringthetwoweeksbeforethecloseofthemailinregistrationdeadline,returncompletedapplicationstoyour respective County Clerk/RegistrarofVoters.AcompletelistofCountyClerk/RegistrarofVotersandregistrationdeadlinesisavailableonNevadaswebsite:www.nvsos.gov.

New Hampshire

Updated: 03-01-2006

Registration Deadline NewHampshiretownandcityclerkswill accept this application only asa request for their own absenteevotermailinregistrationform,whichmustbereceivedbyyourcity or town clerk by 10 days beforthe election.

NewHampshiretownandcityclerkwill accept this application only as arequest for their own absentee votermailinregistrationform.YouneedtollinonlyBox1andBox2or3.eapplicationshouldbemailedto your town or city clerk at yourzipcode.eseaddressesarelisted on the Secretary of Stateweb site at www.state.nh.us/sos/clerks.htmItshouldbemailedinplentyoftimeforyourtownorcityclerktomail

you

their

own

form

and

for

youtoreturnthatformtothemby10 days before the election.

New Jersey

Updated: 03-28-2008


6. ID Number. elast

four

digits

ofyourSocialSecuritynumberORyourNewJerseyDriver'sLicensenumberisrequiredforvoterregistration.Ifyoudonotpossesseitheroftheseidentications,pleasewrite"NONE"ontheform.eStatewillassignanumberthatwill serve to identify you for voterregistrationpurposes.

13
http://www.nvsos.gov/http://www.state.nh.us/sos/clerks.htmhttp://www.state.nh.us/sos/clerks.htmhttp://www.state.nh.us/sos/clerks.htmhttp://www.state.nh.us/sos/clerks.htmhttp://www.state.nh.us/sos/clerks.htmhttp://www.nvsos.gov/


19/25

7. Choice of Party.State Instructions

NewJersey'svoterregistrationformdoesnotprovideacheckoforpoliticalpartyaliation.Anewlyregisteredvoter or voter who has never votedinapoliticalpartyprimaryelectioncan declare party affiliation atthepollingplaceonthedayofaprimaryelection.InNewJersey,aprimaryelectionisonlyheldfortheDemocraticandRepublicanparties.Avotermayalsoleapoliticalpartydeclarationformtobecomeamemberofapoliticalparty. If a declared voter wishedtochangepartyaliationheorshemustleadeclarationform50days

before

the

primary

election,

in order to vote.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinNewJerseyyoumust:

beacitizenoftheUnitedStatesbeatleast18yearsofagebythe

timeofthenextelectionbearesidentofthisStateand

county at your address at least 30daysbeforethenextelection

notbeservingasentenceoronparole or probation as the resultof a conviction of any indictableoenseunderthelawsofthisoranother state or of the United States

Mailing address:NewJerseyDepartmentofLawand Public SafetyDivisionofElectionsPOBOX304Trenton,NJ086250304

New Mexico

Registration Deadline

Updated: 03-01-2006

28daysbefore the election.

6. ID Number. Your full socialsecuritynumberisrequired.isregistrationcardcontainingyoursocialsecuritynumberwillbecomepartofthepermanentvoterregistrationrecordsofyourlocality,which are open to inspectionby the public in the office of thecounty clerk. However, your socialsecuritynumberanddateofbirthwillremaincondentialandwillnot be disclosed to the public.Computerizedlistingsoflimitedvoterregistrationinformation(withoutsocialsecuritynumberorbirthdate)areavailabletothegeneralpublic,andarefurnishedupon

request

to

incumbent

election

officeholders, candidates, politicalparties,courtsandnonprotorganizationspromotingvoterparticipationandregistration,forpoliticalpurposesonly(1519B,NMSA1978).7. Choice of Party. Youmustregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection, caucus, or convention.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinNewMexicoyoumust:

beacitizenoftheUnitedStatesbearesidentoftheStateofNew

Mexicobe18yearsofageatthetimeof

thenextelectionnothavebeendeniedtheright

to vote by a court of law by reasonofmentalincapacityand,ifIhave been convicted of a felony, Ihavecompletedallconditionsofprobation or parole, served theentirety of a sentence or have beengrantedapardonbytheGovernor.

Mailing address:BureauofElections325DonGaspar,Suite300SantaFe,NM87503

New York

Updated: 03-01-2006


6. ID Number. Federallawrequiresthat you provide your driverslicensenumbertoregistertovote.If you do not have a drivers licensethen you will have to provide at leasthelastfourdigitsofyoursocialsecuritynumber.IfyouhaveneitherpleasewriteNONEontheform.AuniqueidentifyingnumberwillbassignedtoyoubyyourState.7. Choice of Party. Youmustenroll with a party if you wanttovoteinthatpartysprimaryelection or caucus.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinNewYorkyoumust:

beacitizenoftheUnitedStatesbearesidentofthecounty,orof

theCityofNewYork,atleast30days before an electionbe18yearsoldbyDecember31oftheyearinwhichyoulethisform(Note: Youmustbe18yearsoldbythedateofthegeneral,primary,orotherelectioninwhichyouwanttovote)

notbeinjailoronparoleforafelony conviction

notcurrentlybejudgedincompetentbyorderofacourtofcompetentjudicialauthority

notclaimtherighttovoteelsewhere

Mailing address:NYSBoardofElections40SteubenStreetAlbany,NY122072108

14


20/25

State Instructions

North Carolina

Updated: 03-01-2006

Registration Deadline Postmarked25daysbeforethe election or received in theelectionsoceordesignatedvoterregistrationagencysiteby5:00p.m.25daysbeforetheelection.6. ID Number. ProvideyourNorthCarolinadriverslicensenumber,orNorthCarolinaDepartmentofMotorVehiclesIDnumber.Ifyou do not have a driver's license,thenlistthelastfourdigitsofyoursocialsecuritynumber.7. Choice of Party. Youmustregisterwithapartytovoteinthatpartysprimaryunlessthatpartyallows unaffiliated voters to voteinitsprimary.Ifyouindicateapoliticalpartythatisnotaqualiedparty, or indicate no party, you willbelistedasUnaliated.8. Race or Ethnic Group. You arerequiredtollinthisbox.However,your application will not be rejectedif you fail to do so. See the list ofchoices under the ApplicationInstructionsforBox8(onpage2).9. Signature. ToregisterinNorthCarolinayoumust:

beacitizenoftheUnitedStatesbearesidentofNorthCarolina

and the county in which you live forat least 30 days prior to the election

be18yearsofagebythedayofthenextgeneralelection

haveyourrightsofcitizenshiprestored if you have been convictedof a felony

notberegisteredorvoteinanyother county or state

Mailing address:

StateBoardofElectionsP.O.Box27255Raleigh,NC276117255

North Dakota

Updated: 03-01-2006

NorthDakotadoesnothavevoterregistration.

Ohio

Updated: 03-01-2006


6. ID Number. Your social securitynumberisrequested.Providingthisnumberisvoluntary.isinformationallowstheBoardofElectionstoverifyyourregistrationifnecessary(O.R.C.3503.14).[Federallaw requires that you provide yourdriverslicensenumbertoregisterto vote. If you do not have a driverslicense then you will have to provideatleastthelastfourdigitsofyoursocialsecuritynumber.IfyoudonthaveeithernumberyouwillhavetowriteNONEontheformandtheStatewillassignyouanumber.]7. Choice of Party. You do notregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection. Party affiliation is establishedbyvotingataprimaryelection.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinOhioyoumust:

beacitizenoftheUnitedStatesbe

aresident

of

Ohio

be18yearsoldonorbefore

electionday.Ifyouwillbe18onorbeforethedayofthegeneralelection,youmayvoteintheprimaryelectionforcandidatesonly.

notbeconvictedofafelonyandcurrently incarcerated

notbefoundincompetentbyacourtforpurposesofvoting

Mailing address:Secretary of State of OhioElectionsDivision180E.BroadStreet15thFlooColumbus,OH43215

Oklahoma

Updated: 10-29-2003


6. ID Number. elastfourdigitsofyoursocialsecuritynumberarerequired.(OklahomaTitle26,Section4112)Inaddition,yourOklahomadriverslicensenumberis requested.7. Choice of Party. Youmustregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection, caucus, or convention.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinOklahomayoumust:

beacitizenoftheUnitedStatesand a resident of the State ofOklahoma

be18yearsoldonorbeforethedateofthenextelection

havenotbeenconvictedofafelony,forwhichaperiodoftimeequaltotheoriginalsentencehasnotexpired,orforwhichyouhavenot been pardoned

notnowbeunderjudgmentasanincapacitated person, or a partiallyincapacitated person prohibitedfromregisteringtovote

Mailing address:OklahomaStateElectionBoardBox528800OklahomaCity,OK731528800

15


21/25

State Instructions

Oregon

Updated: 03-01-2006


6. ID Number. Federallawrequiresthat you provide your driverslicensenumbertoregistertovote.If you do not have a drivers licensethen you will have to provide atleastthelastfourdigitsofyoursocialsecuritynumber.Ifyouhaveneither, you will need to writeNONEontheform.AuniqueidentifyingnumberwillinsteadbeassignedtoyoubyyourState.7. Choice of Party. Youmustregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinOregonyoumust:

beacitizenoftheUnitedStatesbearesidentofOregonbe

at

least

18

years

old

by

election day

Mailing address:Secretary of StateElectionsDivision141StateCapitolSalem,OR973100722

Pennsylvania

Updated: 03-01-2006

Registration Deadline 30 daysbeforeanelectionorprimary.6. ID Number. YoumustsupplyaDriver'sLicenseNumber,ifyouhave one. If you do not have aDriver'sLicenseNumber,youmustsupply the lastfourdigitsof your

socialSecurityNumber.IfyoudonothaveaSocialSecurityNumber,pleasewriteNONEinthebox.7. Choice of Party. Youmustregisterwith a party if you want to take partinthatpartysprimaryelection.8. Race or Ethnic Group.Youarerequestedtollinthisbox.See the list of choices under theApplicationInstructionsforBox8(onpage2).9. Signature. ToregisterinPennsylvaniayoumust:

beacitizenoftheUnitedStatesatleastonemonthbeforethenextelection

bearesidentofPennsylvaniaandyour election district at least 30days before the election

beatleast18yearsofageonthedayofthenextelection

Mailing address:Office of the Secretary oftheCommonwealth210NorthOceBldg.Harrisburg,PA171200029

Rhode IslandUpdated: 03-28-2008


6. ID Number. eapplicantshall be required to provide his/her Rhode Island driver's licensenumberiftheapplicanthasbeenissued a current and valid RhodeIsland driver's license. In the caseof an applicant who has not beenissued a current and valid driver'slicensehe/shemustprovidethelastfour(4)digitsofhis/hersocialsecuritynumber.Anapplicant,whohasneither,willbeassignedauniqueidentifyingnumberbytheState of Rhode Island.

7. Choice of Party. In Rhode Islandapersonmustregisterwithapartyif he/she wishes to take part in thatparty'sprimaryelection.Apersonwhofailstoregisterwithapartyatthetimeofregistrationmay,ifhe/shechooses,registerwithapartyonthedayofthatparty'sprimaryandtakepartinthatparty'sprimaryelection. If a person does notregisterwithaparty,he/shecanstillvoteingeneralelectionsandnonpartisanprimaryelections.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinRhodeIslandyoumust:

beacitizen

of

the

United

States

bearesidentofRhodeIslandfor

30daysprecedingthenextelectionbe18yearsoldbyelectiondaynotbecurrentlyincarceratedina

correctional facility due to a felonyconviction

nothavebeenlawfullyjudgedtobementallyincompetent

Mailing address:RhodeIslandStateBoardofElections50BranchAve.Providence,RI029042790

South Carolina

Updated: 03-01-2006


6. ID Number.Your full socialsecuritynumberisrequired.Itisrequired by the South CarolinaCodeofLawsandisusedforinternal purposes only. Socialsecuritynumberdoesnotappearon any report produced by theStateElectionCommissionnoris it released to any unauthorized

16


22/25

State Instructions

individual. (South Carolina Title75170)7. Choice of Party. You do not havetoregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection, caucus, or convention.

8. Race or Ethnic Group.You arerequiredtollinthisbox.Yourapplicationmayberejectedifyoufail to do so. See the list of choicesunder the Application InstructionsforBox8(onpage2).9. Signature. ToregisterinSouthCarolinayoumust:

beacitizenoftheUnitedStatesbeatleast18yearsoldonor

beforethenextelectionbe

aresident

of

South

Carolina,

your county and precinct

notbeconnedinanypublicprisonresultingfromaconvictionofacrime

neverhavebeenconvictedofafelonyoroenseagainsttheelection laws, or if previouslyconvicted, have served your entiresentence,includingprobationorparole, or have received a pardonfor the conviction

notbeunderacourtorderdeclaringyoumentallyincompetent

claimtheaddressontheapplicationasyouronlylegalplaceofresidenceandclaimnootherplaceasyourlegalresidenceMailing address:

StateElectionCommissionP.O.Box5987Columbia,SC292505987

South Dakota

Updated: 03-01-2006

Registration Deadline Received15daysbeforetheelection.

6. ID Number. Your drivers licensenumberisrequested.Ifyoudonothave a valid driver's license, youmustprovidethelastfourdigitsofyoursocialsecuritynumber.7. Choice of Party. Youmustregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection, caucus, or convention.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinSouthDakotayoumust:

beacitizenoftheUnitedStatesresideinSouthDakotabe18yearsoldbythenext

election

notbe

currently

serving

a

sentence for a felony convictionwhichincludedimprisonment,served or suspended, in an adultpenitentiarysystem

nothavebeenadjudgedmentallyincompetentbyacourtMailing address:

Elections, Secretary of State500E.CapitolPierre,SD575015070

Tennessee

Updated: 03-01-2006


6. ID Number. Your full socialsecuritynumberisrequired.Socialsecuritynumber,ifany,isrequiredforpurposesofidenticationandtoavoidduplicateregistration(TCA2.2.116).7. Choice of Party.You do nothavetoregisterwithapartyifyouwant to take part in that partysprimaryelection,caucus,orconvention.8. Race or Ethnic Group. Optional.

9. Signature. ToregisterinTennesseeyoumust:

beacitizenoftheUnitedStatesbearesidentofTennesseebeatleast18yearsoldonor

beforethenextelectionnothavebeenconvictedofafelony, or if convicted, have had

yourfullrightsofcitizenshiprestored(orhavereceivedapardon

notbeadjudicatedincompetentbyacourtofcompetentjurisdiction (or have been restoredtolegalcapacity)Mailing address:

Coordinator of Elections

TennesseeTower,

Ninth

Floor

312EighthAvenue,NorthNashville,TN37243

Texas

Updated: 03-01-2006


6. ID Number. Youmust

provide

yourdriverslicensenumbertoregistertovote.Ifyoudonothaveadrivers license then you will have toprovideatleastthelastfourdigitsoyoursocialsecuritynumber.Ifyouhaveneither,pleasewriteNONEontheform.Auniqueidentifyingnumberwillinsteadbeassignedtoyou by your State.7. Choice of Party. You do not havetoregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection, caucus, or convention.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinTexasyoumust:

17

beacitizenoftheUnitedStates


23/25

State Instructions

bearesidentofthecountyin which the application forregistrationismade

beatleast17yearsand10monthsold(youmustbe18tovote)

notbenallyconvictedofafelony, or if a convicted felon,youmusthavefullydischargedyourpunishment,includinganyincarceration, parole, supervision,period of probation or be pardoned.

havenotbeendeclaredmentallyincompetentbynaljudgmentofacourt of law

Mailing address:Office of the Secretary of State

ElectionsDivision

P.O.Box12060Austin,TX787112060

Utah

Updated: 03-28-2008

Registration Deadline 30 daysbeforetheelectionformailinapplications;15daysbeforetheelection

for

walkin

registrations

at

the county clerks office.

6. ID Number. Yourcompletedvoterregistrationformmustcontain your state issued driver'slicensenumberornonoperatingidenticationnumber.Ifyoudo not have a driver's license ornonoperatingidentication,youmustincludethelastfourdigitsofyoursocialsecuritynumber.Ifyou do not have a driver's licenseoranonoperatingidenticationorasocialsecuritynumber,pleasewrite"NONE"ontheform.AuniqueidentifyingnumberwillbeassignedbytheState.7. Choice of Party. Declaringaparty is not required in order toregistertovote.However,Utah's

election law allows each politicalpartytochoosewhomitwillallowtovoteinitsprimaryelection.Ifyou do not affiliate with a party,youmayberestrictedfromvotingintheprimary.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinUtahyoumust:

beacitizenoftheUnitedStateshaveresidedinUtahfor30days

immediatelybeforethenextelectionbeatleast18yearsoldonor

beforethenextelectionnotbeaconvictedfeloncurrently

incarceratedforcommissionofafelonynotbeconvictedoftreasonorcrimeagainsttheelectivefranchise, unless restored to civilrights

notbefoundtobementallyincompetentbyacourtoflaw

Mailing address:OceoftheLieutenantGovernorP.O.Box142325SaltLakeCity,UT84114

Vermont

Updated: 07-29-2008

Registration Deadline Deliveredtothetownclerkbefore5:00PMontheWednesdaybeforetheelection.6. ID Number. YoumustprovideyourVermontDriver'slicensenumber,orifnone,thelast4digitsofyourSocialSecuritynumber.IfyoudonothaveaVermontDriver'slicenseoraSocialSecuritynumber,pleasewriteNONEontheform.eSecretaryofState'socewillassignyouauniqueidentifyingnumber.

7. Choice of Party. Vermontdoesnotrequirepartyregistrationtoparticipate in any election.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinVermontyoumust:beacitizenoftheUnitedStates

bearesidentofVermontbe18yearsofageonorbefore

election dayhavetakenthefollowingOath:

Yousolemnlyswear(orarm)thatwheneveryougiveyourvoteorsurage,touchinganymatterthatconcernsthestateofVermont,youwilldoitsoasinyour

conscience

you

shall

judge

willmostconducetothebestgoodofthesame,asestablishedbythe Constitution, without fear orfavorofanyperson[VotersOath,VermontConstitution,ChapterII,Section42]BysigninginBox9,youareattestingthatyouhaveswornorarmedtheVermontvotersoathas printed above.

Mailing address:Office of the Secretary of StateDirectorofElections26 Terrace StreetMontpelier,VT056091101

Virginia

Updated: 11-30-2011

Registration Deadline Delivered22 days before the election.

6. ID Number. Your full socialsecuritynumberisrequired.Yoursocialsecuritynumberwillappearon reports produced only forocialusebyvoterregistrationand election officials and, for juryselection purposes, by courts.

18


24/25

State Instructions

Article II, 2, Constitution ofVirginia(1971).7. Choice of Party.You do nothavetoregisterwithapartyifyouwant to take part in that partysprimaryelection,caucus,orconvention.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinVirginiayoumust:

beacitizenoftheUnitedStatesbearesidentofVirginiaandofthe

precinct in which you want to votebe18yearsoldbythenextMay

orNovembergeneralelectionnothavebeenconvictedofa

felony,or

have

had

your

civil

rights

restored

notcurrentlybedeclaredmentallyincompetentbyacourtoflaw

Mailing address:VirginiaStateBoardofElections1100BankStreet,1stoorRichmond,VA23219

Washington

Updated:-2-20

Registration Deadline 29daysbefore the election (or deliveredinpersontothelocalvoterregistrationoceuntil 8 daysbeforetheelection).6. ID Number. Youmustprovideyour Washington drivers license orstate ID card number.If you donothaveaWashingtondriver'slicense,or state ID card, youmustprovidethelastfourdigitsofyourSocialSecurityNumber.Failuretoprovidethisinformationmaypreventyourregistrationfrombeingprocessed.7. Choice of Party. You are notrequiredtodesignateyourpartyaliationtoregisterinWashington.

8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinWashingtonyoumust:

beacitizenoftheUnitedStatesbealegalresidentofWashington

State, your county and precinct for30daysimmediatelyprecedingtheelection in which you want to vote

beatleast18yearsoldbyelectionday

notbeconvictedofinfamouscrime,unlessrestoredtocivilrights

Mailing address:Secretary of State

Elections DivisionP.O.Box40229Olympia,WA985040229

West Virginia

Updated: 09-12-2006


6. ID Number. Enter your driver'slicensenumber.Ifyoudonothaveadriverslicensenumber,enterthelastfournumbersofyoursocialsecuritynumber.Ifyoudonothaveadriver'slicensenumberorasocialsecuritynumber,anidenticationnumberwillbeassignedtoyou.7. Choice of Party. Youmustregisterwith a party if you want to take part

inthatpartysprimaryelection,caucus, or convention (unless yourequest the ballot of a party whichallowsindependentstovote)8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinWestVirginiayoumust:

beacitizenoftheUnitedStates

liveinWestVirginiaattheaboveaddress

be18yearsold,ortovoteintheprimarybe17yearsoldandturning18beforethegeneralelection

notbeunderconviction,probation, or parole for a felony,treason or election bribery

nothavebeenjudgedmentallyincompetentinacourtofcompetentjurisdictionMailing address:

Secretary of StateBuilding1,Suite157K1900

Kanawha

Blvd.

East

Charleston,WV253050770

Wisconsin

Updated: 09-12-2006

Registration Deadline Twenty(20)daysbeforetheelection(orcompletedinthelocalvoterregistrationoceupto5:00pm.1day

before

the

election,

or

completedatthepollingplaceonelectionday).

6. ID Number. Provide your driver'slicensenumber,ifyouhavenocurrent and valid drivers license, thelast4digitsofyoursocialsecuritynumberorDOTissuedIDcardnumber.7. Choice of Party. Notrequired.8. Race or Ethnic Group. Notrequired.

9. Signature. ToregisterinWisconsinyoumust:

beacitizenoftheUnitedStatesbearesidentofWisconsinforat

least 10 daysbe18yearsoldnothavebeenconvictedof

treason, felony or bribery, or if youhave,yourcivilrightshavebeenrestored

19


25/25

nothavebeenfoundbyacourttobeincapableofunderstandingtheobjective of the electoral process

notmakeorbenetfromabetorwagedependingontheresultofanelection

nothavevotedatanyotherlocation,ifregisteringonelectiondayMailing address:

StateElectionsBoard17WestMainStreet,Suite310P.O.Box2973Madison,WI537012973

Wyoming

Updated: 03-01-2006

Wyomingbylaw,cannotacceptthisformunlessStatelawischanged.

State Instructions

Federal Voter Registration Form 1209 En9242012

Documents

Transcript of Federal Voter Registration Form 1209 En9242012