national mail voter registration form english february 15 2011

8/4/2019 National Mail Voter Registration Form English February 15 2011

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Register To Vote In Your State

By Using This

Postcard Form and Guide

For U.S. Citizens


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1Revised 03/01/2006

General Instructions

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

ofce, Reportachangeofaddresstoyourvoterregistrationoce,or

Registerwithapoliticalparty.

ExceptionsPlease do not use this application i you live outsidetheUnitedStatesanditsterritoriesandhavenohome(legal)addressinthiscountry,or i you are in themilitarystationedawayfromhome.UsetheFederalPostcardApplicationavailabletoyoufrommilitarybases,Americanembassies,orconsularoces.

New Hampshire town and city clerks will accept thisapplication only as a request or their own absentee

votermailinregistrationform.North Dakotadoesnothavevoterregistration.Wyominglawdoesnotpermitmailregistration.

How to Find Out I You Are Eligible to Register toVote in Your StateEachStatehasitsownlawsaboutwhomayregisterand

vote.ChecktheinformationunderyourStateintheState Instructions. All States require that you be a UnitedStatescitizenbybirthornaturalizationtoregistertovoteinfederalandStateelections.FederallawmakesitillegaltofalselyclaimU.S.citizenshiptoregistertovoteinanyederal, State, or local election. You cannotberegisteredtovoteinmorethanoneplaceatatime.

How to Fill Out this ApplicationUse both the Application Instructions and StateInstructionstoguideyouinllingouttheapplication. First,readtheApplicationInstructions.Tese

instructionswillgiveyouimportantinformationthatappliestoeveryoneusingthisapplication.

Next,ndyourStateundertheStateInstructions.UsetheseinstructionstolloutBoxes6,7,and8.

AlsorefertotheseinstructionsforinformationaboutvotereligibilityandanyoathrequiredforBox 9.

When to Register to VoteEachStatehasitsowndeadlineforregisteringtovote.CheckthedeadlineforyourStateonthelastpageofthis booklet.

How to Submit Your ApplicationMail your application to the address listed underyour State in the State Instructions. Or, deliver theapplicationinpersontoyourlocalvoterregistrationoce.TeStatesthatarerequiredtoacceptthenationalformwillacceptcopiesoftheapplicationprintedfromthecomputerimageonregularpaperstock,signedbytheapplicant,andmailedinanenvelopewiththecorrectpostage.

First Time Voters Who Register by MailIfyouareregisteringtovoteforthersttimeinyourjurisdictionandaremailingthisregistrationapplication,Federallawrequiresyoutoshowproofofidenticationthersttimeyouvote.Proofofidenticationincludes: Acurrentandvalidphotoidenticationor Acurrentutilitybill,bankstatement,government

check,paycheckorgovernmentdocumentthat

showsyournameandaddress.VotersmaybeexemptfromthisrequirementiftheysubmitaCOPYofthisidenticationwiththeirmailin

voterregistrationform.IfyouwishtosubmitaCOPY,pleasekeepthefollowinginmind: Yourstatemayhaveadditionalidentication

requirementswhichmaymandateyoushowidenticationatthepollingplaceevenifyoumeettheFederalproofofidentication.

Donotsubmitoriginaldocumentswiththisapplication, onlyCOPIES.

I You Were Given this Application in a StateAgency or Public OfceIfyouhavebeengiventhisapplicationinaStateagencyorpublicoce,itisyourchoicetousetheapplication. I you decide to use this application toregistertovote,youcanllitoutandleaveitwiththeStateagencyorpublicoce.Teapplicationwillbesubmittedforyou.Or,youcantakeitwithyoutomailtotheaddresslistedunderyourStateintheStateInstructions.Youalsomaytakeitwith you to deliver in person to your local voter

registrationoce.Note:TenameandlocationoftheStateagencyor public ofce where you received the applicationwillremaincondential.Itwillnotappearonyourapplication. Also, i you decide not to use thisapplicationtoregistertovote,thatdecisionwillremaincondential.Itwillnotaecttheserviceyoureceivefromtheagencyoroce.


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Box 1 Name

PutinthisboxyourfullnameinthisorderLast,First,Middle.Donotusenicknamesorinitials.Note:Ifthisapplicationisforachangeofname,pleasetell us in Box A(on the bottom half of the form) yourfullnamebeforeyouchangedit.

Box 2 Home AddressPutinthisboxyourhomeaddress(legaladdress).Donotputyourmailingaddresshereifitisdierentfromyourhomeaddress.Donotuseapostoceboxorruralroutewithoutaboxnumber.Refertostatespecicinstructionsforrulesregardinguseofroutenumbers.

Note:IfyouwereregisteredbeforebutthisisthersttimeyouareregisteringfromtheaddressinBox2,please tell us in Box B(on the bottom half of the form)theaddresswhereyouwereregisteredbefore.Pleasegiveusasmuchoftheaddressasyoucanremember.

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

Box 3 Mailing AddressIfyougetyourmailatanaddressthatisdierentfromtheaddressinBox2,putyourmailingaddressinthisbox.IfyouhavenoaddressinBox2,youmust write inBox3anaddresswhereyoucanbereachedbymail.

Box 4 Date of BirthPutinthisboxyourdateofbirthinthisorderMonth,Day,Year.Be careful not to use todays date!

Box 5 Telephone NumberMostStatesaskforyourtelephonenumberincasethere are questions about your application. However,you do nothavetollinthisbox.

Box 6 ID NumberFederallawrequiresthatstatescollectfromeachregistrantanidenticationnumber.Youmustrefertoyourstate'sspecicinstructionsforitem6regardinginformationonwhatnumberisacceptableforyourstate. If you have neither a drivers license nor a socialsecuritynumber,pleaseindicatethisontheformandanumberwillbeassignedtoyoubyyourstate.

Box 7 Choice of Party

InsomeStates,youmustregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection,caucus,orconvention.TondoutifyourStaterequirethis,seeitem7intheinstructionsunderyourState.

Ifyouwanttoregisterwithaparty,printintheboxthefullnameofthepartyofyourchoice.

If you do notwanttoregisterwithaparty,writenopartyorleavetheboxblank.Donot write in the wordindependentifyoumeannoparty,becausethismightbeconfusedwiththenameofapoliticalpartyinyour State.

Note: Ifyoudonotregisterwithaparty,youcanstillvoteingeneralelectionsandnonpartisan(nonparty)primaryelections.

Box 8 Race or Ethnic GroupAfewStatesaskforyourraceorethnicgroup,inordertoadministertheFederalVotingRightsAct.TondoutifyourStateasksforthisinformation,seeitem8intheinstructionsunderyourState.Ifso,putinBox8thechoicethatbestdescribesyoufromthelistbelow: AmericanIndianorAlaskanNative AsianorPacicIslander

Black,not ofHispanicOrigin Hispanic Multiracial White,not ofHispanicOrigin Other

Box 9 SignatureReviewtheinformationinitem9intheinstructionsunderyourState.Beforeyousignormakeyourmark,makesurethat:

(1)YoumeetyourStatesrequirements,and(2)YouunderstandallofBox9.

Finally,signyourfullnameormakeyourmark,andprinttodaysdateinthisorderMonth,Day,Year.Iftheapplicantisunabletosign,putinBox D thename,address,andtelephonenumber(optional)ofthperson who helped the applicant.

Application Instructions

Beforellingoutthebodyoftheform,pleaseanswerthequestionsonthetopoftheformastowhetheryouareaUnitedStatescitizenandwhetheryouwillbe18yearsoldonorbeforeElectionDay.Ifyouanswernotoeitherofthesquestions,youmaynotusethisformtoregistertovote.However,statespecicinstructionsmayprovideadditionalinformationoneligibilitytoregistertovotepriortoage18.

Revised 03/01/2006


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Voter Registration ApplicationBeore completing this orm, review the General, Application, and State specifc instructions.

Please fll out the sections below i they apply to you.

I this application is or a change o name, what was your name beore you changed it?

ALast Name First Name Middle Name(s)

I you were registered beore but this is the frst time you are registering rom the address in Box 2 , what was your address where you were registered beore?

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

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

C

Write in the names o 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 landmarks

near where you live, and write the name o the landmark.

I 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 or your State.

Example

Public School

Grocery Store

Route

#2

X

Woodchuck Road

NORTH

Are you a citizen o the United States o America?

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

This space or ofce use only.

1Last Name First Name Middle Name(s)

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

3Address Where You Get Your Mail I Diferent From Above City/Town State Zip Code

4

Date o Birth

Month Day Year

5

Telephone Number (optional)

6

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

7Choice o Party(see item 7 in the instructions oy your State) 8

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

9

I have reviewed my state's instructions and I swear/afrm that:I am a United States citizenI meet the eligibility requirements o my state and

subscribe to any oath required.

The inormation I have provided is true to the best o myknowledge under penalty o perjury. I I have provided alseinormation, I may be ned, imprisoned, or (i not a U.S.citizen) deported rom or reused entry to the United States.

Please sign ull name (or put mark)

Date:

Month Day Year

I you are registering to vote or the frst time: please reer to the application instructions or inormation on submittingcopies o valid identication documents with this orm.

Yes

Yes

Mr.NGUYEN HAI LONG

315 15TH STREET LOGANSPORT IN 46947

09/08/1984

3850-03-9964


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FIRST CLASSSTAMP

NECESSARY

FORMAILING

FOR OFFICIAL USE ONLY

Print Application


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Voter Registration ApplicationBeore completing this orm, review the General, Application, and State specifc instructions.

Please fll out the sections below i they apply to you.I this application is or a change o name, what was your name beore you changed it?

AMr.Mrs.MissMs.

Last Name First Name Middle Name(s) (Circle one)

Jr Sr II III IV

I you were registered beore but this is the frst time you are registering rom the address in Box 2 , what was your address where you were registered beore?

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

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

C

Write in the names o 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 landmarks

near where you live, and write the name o the landmark.

I 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 or your State.

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

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

This space or ofce use only.

1(Circle one)

Mr. Mrs. Miss Ms.

Last Name First Name Middle Name(s) (Circle one)

Jr Sr II III IV

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

3Address Where You Get Your Mail I Diferent From Above City/Town State Zip Code

4

Date o Birth

Month Day Year

5

Telephone Number (optional)

6

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

7Choice o Party(see item 7 in the instructions oy your State) 8

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

9

I have reviewed my state's instructions and I swear/afrm that:

I am a United States citizenI meet the eligibility requirements o my state and

subscribe to any oath required.

The inormation I have provided is true to the best o myknowledge under penalty o perjury. I I have provided alseinormation, I may be ned, imprisoned, or (i not a U.S.citizen) deported rom or reused entry to the United States.

Please sign ull name (or put mark)

Date:

Month Day Year

I you are registering to vote or the frst time: please reer to the application instructions or inormation on submittingcopies o valid identication documents with this orm.

Example

Public School

Grocery Store

Route

#2

X

Woodchuck Road

NORTH


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FIRST CLASSSTAMP

NECESSARY

FORMAILING

FOR OFFICIAL USE ONLY


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State Instructions

Alabama

Updated: 03-01-2006

Registration Deadline Voterregistrationisclosedduringthe

tendaysprecedinganelection.Applicationsmustbepostmarkedor delivered by the eleventh dayprior to the election.

6. ID Number. Your social securitynumberisrequested(byauthorityoftheAlabamaSupremeCourt,174122).7. Choice of Party. Optional: Youdonothavetoregisterwithaparty

i you want to take part in thatpartysprimaryelection,caucus, or convention.8. Race or Ethnic Group. Youarerequiredtollinthisbox;however, your application willnot be rejected i you ail to do so.See the list o choices under theApplicationInstructionsforBox8(onpage2).9. Signature.Toregisterin

Alabamayoumust:beacitizenoftheUnitedStatesbearesidentofAlabamaandyourcountyatthetimeofregistrationbe18yearsoldbeforeanyelectionnothavebeenconvictedofafelonypunishablebyimprisonmentinthepenitentiary (or have had your civilandpoliticalrightsrestored)notcurrentlybedeclaredmentallyincompetentthroughacompetencyhearingswearorarmtosupportanddeend the Constitution o theU.S.andtheStateofAlabamaand urther disavow any belie oraliationwithanygroupwhichadvocates the overthrow o thegovernmentsoftheU.S.ortheStateofAlabamabyunlawfulmeans

andthattheinformationcontainedhereinistrue,sohelpmeGod

Mailing address:Oce o the Secretary o StateP.O.Box5616

Montgomery,AL361035616

Alaska

Updated: 03-01-2006

Registration Deadline 30daysbeore the election.

6. ID Number. Youmustprovideoneofthefollowingidenticationnumbers;AlaskaDriver'sLicenseorAlaskaStateIdenticationCardNumber.IfyoudonothaveanAlaskaDriver'sLicenseorAlaskaStateIdenticationCard,youmustprovidethelastfourdigitsofyourSocialSecurityNumber.Ifyoudonothaveanyoftheseidenticationnumbers,pleasewrite"NONE"ontheform.Auniqueidentifyingnumberwillbeassignedtoyoufor

voterregistrationpurposes.isinformationiskeptcondential.Havingthisinformationassistsinmaintainingyourvoterrecordandmayassistinverifyingyouridentity (Title 15 o the AlaskaStatutes).7. Choice of Party. You do nothave to declare a party aliationwhenregisteringtovote.Ifyoudo not choose a party, you will

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

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

beatleast18yearsoldwithin90daysofcompletingthisregistrationbearesidentofAlaskanotbeaconvictedfelon(unlessunconditionallydischarged)notberegisteredtovoteinanother State

Mailing address:DivisionofElectionsState o Alaska

POBox110017Juneau,AK998110017

Arizona

Updated: 03-01-2006


6. ID Number.Yourcompleted

voterregistrationformmustcontainthenumberofyourArizona driver license, ornonoperatingidenticationlicense issued pursuant to A.R.S.283165,ifthelicenseiscurrentand valid. I you do not havea current and valid Arizonadriverlicenseornonoperatingidenticationlicense,youmustincludethelastfourdigitsof

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


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State Instructions

7. Choice of Party. I you areregisteredinapoliticalpartywhichhasqualiedforballotrecognition,youwillbepermittedtovotetheprimaryelectionballotforthatparty.Ifyouareregisteredasan

independent, no party preerenceorasamemberofapartywhichisnotqualiedforballotrecognition,youmayselectandvoteoneprimaryelectionballotforoneoftherecognizedpoliticalparties.8. Race or Ethnic Group.Leaveblank.9. Signature.ToregisterinArizonayoumust:beacitizenoftheUnitedStates

bearesidentofArizonaandyourcountyatleast29daysprecedingthenextelectionbe18yearsoldonorbeforethenextgeneralelectionnothavebeenconvictedoftreason or a elony (or have hadyourcivilrightsrestored)notcurrentlybedeclaredanincapacitated person by a courto law

Mailing address:Secretary o State/Elections1700W.Washington,7thFloorPhoenix,AZ850072888

Arkansas

Updated: 03-01-2006

Registration Deadline 30days

beore 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.Auniqueidentifyingnumberwillbe

assignedbytheState.7. Choice of Party. Optional. Youdonothavetoregisterwithapartyi you want to take part in thatpartysprimaryelection,caucus,orconvention.8. Race or Ethnic Group.Leaveblank.9. Signature.ToregisterinArkansasyoumust:beacitizenoftheUnitedStates

liveinArkansasattheaddressinBox2ontheapplicationbeatleast18yearsoldbeforethenextelectionnotbeaconvictedfelon(orhavecompletelydischargedyoursentenceorbeenpardoned)notclaimtherighttovoteinanyother jurisdictionnotpreviouslybeadjudgedmentallyincompetentbyacourtofcompetentjurisdiction

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

California

Updated: 03-01-2006

Registration Deadline 15 daysbeore the election.

6. ID Number. Whenyouregistertovote,youmustprovideyourCaliornia 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.Caliornia law allows voters whodeclinetostateanaliationwithaqualiedpoliticalpartyorwhoaliatewithanonqualiedpoliticapartytovoteintheprimaryelection

ofanyqualiedpoliticalpartythatlesanoticewiththeSecretaryofStateallowingthemtodoso.Youcancall1800345VOTEor visit www.ss.ca.govto learnwhichpoliticalpartiesareallowingnonaliated voters to participate intheirprimaryelection.8. Race or Ethnic Group.Leaveblank.9. Signature. ToregisterinCaliforniayoumust:beacitizenoftheUnitedStatesbearesidentofCaliforniabeatleast18yearsofageatthetimeofthenextelectionnotbeimprisonedoronparoleor the conviction o a elonynotcurrentlybejudgedmentallyincompetentbyacourtoflawSignatureisrequired.Ifyoumeettherequirementslistedabove,pleasesignanddatethe

registrationcardinthespaceprovided.

Mailing address:Secretary o StateElectionsDivision1500 11th StreetSacramento,CA95814


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State Instructions

Colorado

Updated: 03-28-2008

Registration Deadline 29days beore the election. I the

applicationisreceivedinthemailswithoutapostmark,itmustbereceived within 5 days o the closeofregistration.

6. ID Number. Yourcompletedvoterregistrationformmustcontainyour state issued driver's licensenumberoridenticationnumber.I you do not have a driver's licenseorstateissuedidentication,you

mustincludethelastfourdigitsofyoursocialsecuritynumber.Ifyou do not have a driver's licenseorastateissuedidenticationorasocialsecuritynumber,pleasewrite"NONE"ontheform.Auniqueidentifyingnumberwillbeassignedby the State.7. Choice of Party.Youmustregisterwithapartyifyouwanttotakepartinthatpartysprimary

election, caucus, or convention.8. Race or Ethnic Group.Leaveblank.9. Signature.ToregisterinColoradoyoumust:beacitizenoftheUnitedStatesbearesidentofColorado30daysprior to the electionbe18yearsoldonorbeforeelection daynotbeconnedasaprisonerorservinganypartofasentenceundermandate

Mailing address:Colorado Secretary o State1700Broadway,Suite270Denver,Colorado80290

Connecticut

Updated: 03-01-2006


6. ID Number. ConnecticutDriver'sLicenseNumber,orifnone,thelastfourdigitsofyourSocialSecurityNumber.7. Choice of Party.isisoptional,butyoumustregisterwith a party i you want to takepartinthatpartysprimaryelection, caucus, or convention.8. Race or Ethnic Group.Leave

blank.9. Signature.ToregisterinConnecticutyoumust:beacitizenoftheUnitedStatesbearesidentofConnecticutand o the town in which you wishto votebe17yearsold.Youcanvotewhenyouturn18havecompletedconnementandparole if previously convicted of a

felony,andhavehadyourvotingrightsrestoredbyRegistrarsofVoters.notcurrentlybedeclaredmentallyincompetenttovotebyacourtoflaw

Mailing address:Secretary o StateElectionsDivision30TrinityStreetHartford,CT06106

DelawareUpdated: 03-28-2008

Registration Deadline e4thSaturdaybeforeaprimaryorgeneralelection,and10daysbeore 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.Youmustregisterwithapartyifyouwantto

takepartinthatpartysprimaryelection, caucus, or convention.8. Race or Ethnic Group.Leaveblank.9. Signature. ToregisterinDelawareyoumust:beacitizenoftheUnitedStatesbeapermanentresidentofDelawarebeatleast18yearsoldonthedateofthenextgeneralelectionfelonsareeligibletovoteifcertainrequirementsaremet:nesandsentencecompletedatleastveyearspriortoapplicationdate;felonyconvictionscannotbedisqualifyingfelonies,whicharemurder,sexualoenses,orcrimesagainstpublicadministrationinvolvingbriberyorimproperinfuence or abuse o oce.notbementallyincompetent

Mailing address:CommissionerofElections111S.WestSt.,Suite10Dover,DE19904


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State Instructions

District of Columbia

Updated: 10-29-2003


6. ID Number.Federallawnowrequiresthatallvoterregistrationapplicationsmustincludeeitherthe applicants drivers licensenumberorthelastfourdigitso the applicants social securitynumberinordertobeprocessed.7. Choice of Party.Youmustregisterwithapartyifyouwanttotakepartinthatpartysprimary

election, caucus, or convention.8. Race or Ethnic Group.Leaveblank.9. Signature.ToregisterintheDistrictofColumbiayoumust:beacitizenoftheUnitedStatesbeaDistrictofColumbiaresidentatleast30daysprecedingthenextelectionbeatleast18yearsoldonorprecedingthenextelection

notbeinjailforafelonyconvictionnothavebeenjudgedmentallyincompetentbyacourtoflawnotclaimtherighttovoteanywhereoutsideD.C.

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

Florida

Updated: 09-12-2006


6. ID Number. I you have one,youmustprovideyourFloridadriver'slicensenumberorFloridaidenticationcardnumber.IfyoudonothaveaFloridadriver'slicenseoridenticationcard,you

mustprovidethelastfourdigitsofyoursocialsecuritynumber.7. Choice of Party.Youmustregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection, caucus, or convention.8. Race or Ethnic Group. Youarerequestedtollinthisbox.See the list o choices under theApplicationInstructionsforBox8(onpage2).

9. Signature.ToregisterinFloridayoumust:beacitizenoftheUnitedStatesbealegalresidentofboththeStateofFloridaandofthecountyinwhichyouseektoberegisteredbe18yearsold(youmaypreregisterifyouare17)notnowbeadjudicatedmentallyincapacitatedwithrespecttovotinginFloridaoranyotherStatenothavebeenconvictedofafelonywithoutyourcivilrightshavingbeenrestored pursuant to lawnotclaimtherighttovoteinanother county or stateswearorarmthefollowing:IwillprotectanddefendtheConstitution of the United Statesand the Constitution of the State ofFlorida,thatIamqualiedtoregisteras an elector under the ConstitutionandlawsoftheStateofFlorida,and

thatIamacitizenoftheUnitedStatesandalegalresidentofFlorida

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

Georgia

Updated: 03-28-2008

Registration Deadline ehMondaybeforeanygeneral

primary,generalelection,orpresidentialpreferenceprimary,orregularlyscheduledspecialelectiopursuanttotheGeorgiaElectionCode. In the event that a specialelection is scheduled on a dateother that those dates prescribedbytheGeorgiaElectionCode,registrationwouldcloseonthe5thdayaerthecall.

6. ID Number.FederallawrequiresyoutoprovideyourfullGADriverLicensenumberorGAStateissuedIDnumber.IfyoudonothaveaGADriversLicenseorGAIDyoumusprovidethelast4digitsofyourSocialSecuritynumber.ProvidingyourfullSocialSecuritynumberis optional. Your Social Securitynumberwillbekeptcondentialandmaybeusedforcomparison

withotherstateagencydatabasesforvoterregistrationidenticationpurposes. I you do not possessaGADriversLicenseorSocialSecuritynumber,auniqueidentiewill be provided or you.7. Choice of Party. You do nothavetoregisterwithapartytotakpartinthatpartysprimary,caucusor convention.8. Race or Ethnic Group. Youarerequestedtollinthisbox.See the list o choices under theApplicationInstructionsforBox8(onpage2).9. Signature.ToregisterinGeorgiayoumust:beacitizenoftheUnitedStatesbealegalresidentofGeorgiaando the county in which you wantto vote


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State Instructions

be18yearsoldwithinsixmonthsaerthedayofregistration,andbe18yearsoldtovotenotbeservingasentenceforhavingbeenconvictedofafelonynothavebeenjudicially

determinedtobementallyincompetent,unlessthedisabilityhasbeenremoved

Mailing address:ElectionsDivisionOce o the Secretary o State1104WestTower2MartinLutherKing,Jr.Dr.SEAtlanta,GA303341505

Hawaii

Updated: 03-01-2006


6. ID Number. Your ull socialsecuritynumberisrequired.Itis used to prevent raudulentregistrationandvoting.Failure

tofurnishthisinformationwill prevent acceptance o thisapplication (Hawaii RevisedStatutes,Section1115).7. Choice of Party.Achoiceofparty is not required or voterregistration.8. Race or Ethnic Group. Race orethnicgroupinformationisnotrequiredforvoterregistration.9. Signature.ToregisterinHawaii

youmust:beacitizenoftheUnitedStatesbearesidentoftheStateofHawaiibeatleast16yearsold(youmustbe18yearsoldbyelectiondayinordertovote)

notbeincarceratedforafelonyconvictionnotbeadjudicatedbyacourtasnoncomposmentis

Mailing address:

Oce o ElectionsState o Hawaii802LehuaAvenuePearlCity,HI96782

Idaho

Updated: 03-01-2006

Registration Deadline 25 daysbeore 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.ToregisterinIdaho

youmust:beacitizenoftheUnitedStateshaveresidedinIdahoandinthecountyfor30dayspriortothedayo electionbeatleast18yearsoldnothavebeenconvictedofafelony,andwithouthavingbeenrestoredtotherightsofcitizenship,orconnedinprisononconvictionofacriminaloense

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

Illinois

Updated: 03-01-2006

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.Partyregistration

or preference is not required forvoterregistration.However,whenyouapplyforaprimaryballot,youmustindicateyourpartypreferencefor that election.8. Race or Ethnic Group.Leaveblank.9. Signature.Asignatureisrequired.Ifsignatureismissingfromregistrationform,youwillbenotiedyourregistrationis

incomplete.ToregisterinIllinoisyoumust:beacitizenoftheUnitedStatesbearesidentofIllinoisandofyourelectionprecinctatleast30daysbeforethenextelectionbeatleast18yearsoldonorbeforethenextelectionnotbeinjailforafelonyconvictionnotclaimtherighttovoteanywhere else

Mailing address:StateBoardofElections1020S.SpringStreetSpringeld,IL62704


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State Instructions

Indiana

Updated: 03-01-2006


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

blank.9. Signature.ToregisterinIndianayoumust:beacitizenoftheUnitedStateshaveresidedintheprecinctatleast30daysbeforethenextelectionbeatleast18yearsofageonthedayofthenextgeneralelectionnotcurrentlybeinjailforacriminalconviction

Mailing address:ElectionDivisionOce o the Secretary o State302WestWashingtonStreet,RoomE204Indianapolis,IN462042743

Iowa

Updated: 03-28-2008

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

*Ifyoufailtomeetthevoterregistrationdeadlinesaboveyoucanregisterandvotebyfollowingtheguidelinesforelectiondayregistration.Youcanndtheseon the Iowa Secretary o States

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

6. ID Number.YourIDnumberisyourIowadriver'slicensenumber(orIowanondriveridenticationnumber)ifyouhaveone,ifnotthenthelastfourdigitsofyoursocialsecuritynumber.eIDnumberyouprovidewillbeveriedwiththeIowaDepartment

o Transportation or the SocialSecurityAdministration.7. Choice of Party.Youmay,butdonothaveto,registerwithapartyin advance i you want to take partinthatpartysprimaryelection.Youmaychangeordeclareapartyaliationatthepollsonprimaryelection day.8. Race or Ethnic Group.Leaveblank.9. Signature.ToregisterinIowayoumust:beacitizenoftheUnitedStatesbearesidentofIowabeatleast171/2yearsold(youmustbe18tovote)nothavebeenconvictedofafelony(orhavehadyourrightsrestored)notcurrentlybejudgedbyacourttobe"incompetenttovote"notclaimtherighttovotein

morethanoneplacegiveupyourrighttovoteinanyother place

Mailing address:ElectionsDivisionOce o the Secretary o StateLucasBuilding1stFloor321E.12thStreetDesMoines,IA50319

Kansas

Updated: 03-01-2006

Registration Deadline Postmarkedordelivered15daysbeore the election.

6. ID Number.Yourcompletedvoterregistrationformmustcontain your state issued driver'slicensenumberornondriver'sidenticationcardnumber.Ifyoudo not have a driver's license ornondriver'sidenticationcard, youmustincludethelastfourdigitsofyoursocialsecuritynumber.If

you do not have a driver's licenseor a nondriver'sidenticationcardorsocialsecuritynumber,pleasewrite"NONE"ontheform.AuniqueidentifyingnumberwillbeassignedbytheState.enumberyou provide will be used oradministrativepurposesonlyandwill not be disclosed to the public.(KSA252309).7. Choice of Party.Youmust

registerwithapartyifyouwanttotakepartinthatpartysprimaryelection, caucus, or convention.8. Race or Ethnic Group.Leaveblank.9. Signature.ToregisterinKansasyoumust:beacitizenoftheUnitedStatesbearesidentofKansasbe18bythenextelectionhavecompletedthetermsofyoursentenceifconvictedofafelony;apersonservingasentenceforafelonyconvictionisineligibletovotenotclaimtherighttovoteinanyother location or under any othernamenotbeexcludedfromvotingformentalincompetencebyacourtocompetentjurisdiction


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State Instructions

Mailing address:Secretary o State1stFloor,MemorialHall 120SW10thAve.Topeka,KS666121594

Kentucky

Updated: 03-01-2006


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

public(KRS116.155).Nopersonshallbedeniedtherighttoregisterbecause o ailure to include socialsecuritynumber.7. Choice of Party. Youmustregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection, caucus, or convention.8. Race or Ethnic Group.Leaveblank.9. Signature.Toregisterin

Kentuckyyoumust:beacitizenoftheUnitedStatesbearesidentofKentuckybearesidentofthecountyforatleast28dayspriortotheelectiondatebe18yearsofageonorbeforethenextgeneralelectionnotbeaconvictedfelonorifyouhave been convicted o a elony,yourcivilrightsmusthavebeenrestoredbyexecutivepardon

nothavebeenjudgedmentallyincompetentinacourtoflawnotclaimtherighttovoteanywhere outside Kentucky

Mailing address:StateBoardofElections140WalnutStreetFrankfort,KY406013240

Louisiana

Updated: 03-01-2006


6. ID Number. YoumustprovideyourLouisianadriver'slicensenumber,ifissued.Ifnotissued,youmustprovideatleastthelastfourdigitsofyoursocialsecuritynumber,ifissued.efullsocialsecuritynumbermaybeprovidedonavoluntarybasis.NeithertheregistrarnortheDepartmento State shall disclose the social

securitynumberofaregisteredvoter or circulate the socialsecuritynumbersofregisteredvotersoncommerciallists(R.S.18:104and154;42U.S.C.405).7. Choice of Party. I you do notlist a party aliation, you cannotvote in the Presidential PreerencePrimaryandpartycommitteeelections. Political party aliation isnot required or any other election.

8. Race or Ethnic Group. Youarerequestedtollinthisbox.See the list o choices under theApplicationInstructionsforBox8(onpage2).9. Signature.ToregisterinLouisianayoumust:beacitizenoftheUnitedStatesbearesidentofLouisiana.Residenceaddressmustbeaddresswhereyouclaimhomesteadexemption,ifany.beatleast17yearsold,andbe18yearsoldpriortothenextelectionto votenotcurrentlybeunderanorderofimprisonmentforconvictionofa elonynotcurrentlybeunderajudgmentofinterdictionformentalincompetence

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

Maine

Updated: 03-01-2006

Registration Deadline Delivered10 business days beore the election(oravotermayregisterin-person uptoandincludingelectionday).

6. ID Number. Youmustlistyour valid Maine driver's license

number.Ifyoudon'thaveavalidMaine driver's license, then youmustprovidethelastfourdigitsofyourSocialSecurityNumber.Voters who don't have either otheseformsofIDmustwrite"NONE"inthisspace.7. Choice of Party.Youmustregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection, caucus, or convention

(unlessotherwisepermittedbyapoliticalparty).8. Race or Ethnic Group.Leaveblank.9. Signature.ToregisterinMaineyoumust:beacitizenoftheUnitedStatesbearesidentofMaineandthemunicipalityinwhichyouwant to votebeatleast17yearsold(youmust

be18yearsoldtovote)

Mailing address:ElectionsDivisionBureauofCorporations,ElectionsandCommissions101 State House StationAugusta,ME043330101


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State Instructions

Maryland

Updated: 06-26-2008

Registration Deadline 9:00p.m.21daysbeforetheelection.

6. ID Number. I you have acurrent, valid Maryland driverslicense or a Motor VehicleAdministrationidenticationcard,youmustenterthedriverslicenseoridenticationnumber.Ifyoudonot have a current, valid Marylanddrivers license or Motor VehicleAdministrationidenticationcard,youmustenteratleastthe

last4digitsofyoursocialsecuritynumber.However,pleasenote,the disclosure o your ull SocialSecuritynumberisvoluntary.estatutoryauthorityallowingelectionocials to request your ull SocialSecuritynumberisElectionLawArticle,Section3202,AnnotatedCodeofMaryland.enumberwillbeusedonlyforregistrationandotheradministrativepurposes.It

willbekeptcondential.7. Choice of Party.Youmustregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection.8. Race or Ethnic Group.Leaveblank.9. Signature.ToregisterinMarylandyoumust:beaU.S.citizenbeaMarylandresidentbeatleast18yearsoldbythenextgeneralelectionnotbeunderguardianshipformentaldisabilitynothavebeenconvictedofbuyingorsellingvotesnothavebeenconvictedofaelony, or i you have, you havecompletedservingacourtorderedsentenceofimprisonment,

includinganytermofparoleorprobation or the conviction.

Mailing address:StateBoardofElectionsP.O.Box6486

Annapolis,MD214010486

Massachusetts

Updated: 03-01-2006


6. ID Number.Federallawrequires that you provide your

driverslicensenumbertoregisterto vote. I you do not have acurrent and valid Massachusettsdriverslicensethenyoumustprovidethelastfour(4)digitsofyoursocialsecuritynumber.Ifyouhaveneither,youmustwriteNONEintheboxandauniqueidentifyingnumberwillbeassignedtoyou.7. Choice of Party. I you do

notdesignateapartyofpoliticaldesignationinthisbox,youwillberegisteredasunenrolled.Unenrolledvotersmayparticipateinpartyprimaries.However,anunenrolledvotermustenrollinaparty on the day o the PresidentialPreferencePrimaryinordertoparticipateinthatprimary.8. Race or Ethnic Group.Leaveblank.

9. Signature.ToregisterinMassachusettsyoumust:beacitizenoftheUnitedStatesbearesidentofMassachusettsbe18yearsoldonorbeforethenextelectionnothavebeenconvictedofcorrupt practices in respect toelections

notbeunderguardianshipwithrespecttovotingnotbecurrentlyincarceratedfora elony conviction

Mailing address:

SecretaryoftheCommonwealthElectionsDivision,Room1705One Ashburton PlaceBoston,MA02108

Michigan

Updated: 03-01-2006


6. ID Number. Yourcompletedvoterregistrationformmustcontain your state issued driver'slicensenumberorstateissuedpersonalidenticationcardnumber.Ifyoudonothaveadriver's license or state issuedpersonalidenticationcard,youmustincludethelastfourdigitsofyoursocialsecuritynumber.Ifyou

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:beacitizenoftheUnitedStatesbe18yearsoldbythenextelectionbearesidentofMichiganandatleasta30dayresidentofyourcityor township by election daynotbeconnedinajailaerbeingconvictedandsentenced


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State Instructions

Notice:Michiganlawrequiresthatthesameaddressbeusedforvoterregistrationanddriverlicensepurposes.erefore,iftheresidenceaddressyouprovideonthisformdiersfromtheaddressshown

on a driver license or personalidenticationcardissuedbytheStateofMichigan,theSecretaryofStatewillautomaticallychangeyour driver license or personalidenticationcardaddresstomatchthe residence address entered onthisform.Ifanaddresschangeismade,theSecretaryofStatewillmailyouanaddressupdatestickeror your driver license or personal

identicationcard.Caution:Ifyouregisterbymail,youmustvoteinpersonatyourassignedprecinctthersttimeyouvote, unless you are:

disabledasdenedbystatelaw; 60yearsofageorolder;or temporarilyresidingoverseas.

Mailing address:MichiganDepartmentofState BureauofElectionsP.O.Box20126Lansing,MI489010726

Minnesota

Updated: 12-31-2008

Registration Deadline Deliveredby5:00p.m.21daysbeore the election (there is alsoelectiondayregistrationatpollingplaces).

6. ID Number. You are requiredto provide your Minnesota driverslicenseorstateIDnumbertoregistertoVote.Ifyoudonothavea Minnesota drivers license or stateIDthenyouwillhavetoprovide

thelastfourdigitsofyoursocialsecuritynumber.Ifyouhaveneither,pleasewritenoneontheform.7. Choice of Party. Leaveblank.8. Race or Ethnic Group. Leaveblank.

9. Signature. ToregisterinMinnesotayoumust:beacitizenoftheUnitedStatesbearesidentofMinnesotafor20daysbeforethenextelectionmaintainresidenceattheaddressgivenontheregistrationformbeatleast18yearsoldonelection dayifpreviouslyconvictedofafelony,yourfelonysentencehasexpiredor

beencompleted,oryouhavebeendischargedfromthesentencenotbeunderacourtorderedguardianshipinwhichtherighttovote has been revokednotbefoundbyacourttobelegallyincompetenttovote.

Mailing address:Secretary o State60EmpireDrive,Suite100 St.Paul,MN551031855

Mississippi

Updated: 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:beacitizenoftheUnitedStateshavelivedinMississippiandin

yourcounty(andcity,ifapplicable)30daysbeforetheelectioninwhich you want to votebe18yearsoldbythetimeofthegeneralelectioninwhichyouwantto votehavenotbeenconvictedofmurder,rape,bribery,the,arson,obtainingmoneyorgoodsunderfalsepretense,perjury,forgery,embezzlement,armedrobbery,

extortion,felonybadcheck,felonyshopliing,larceny,receivingstolenproperty,robbery,timberlarceny,unlawfultakingofamotorvehicle,statutoryrape,carjacking,orbigamy,orhavehadyourrightsrestored as required by lawnothavebeendeclaredmentallyincompetentbyacourtNote:Statelawchangedbyfederalcourtorderin1998andbystatelegislationin2000.Wenowaccepttheformasregistrationforvotingor all state and ederal oces.

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

Local county addresses: Youalsomayreturncompleted

applications to the county

circuitclerk/registrarwhereyoureside.Acompletelistofcountycircuitclerk/registrarsis available on Mississippiswebsiteatwww.sos.ms.gov.


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State Instructions

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,please

write"NONE"ontheform.AuniqueidentifyingnumberwillbeassignedbytheState.Anyelectronicmedia,printoutsormailinglabelsprovidedunderthissection shall not include telephonenumbersandsocialsecuritynumbersofvoters.(Section115.157,RSMo).7. Choice of Party. You do not havetoregisterwithapartyifyouwant

totakepartinthatpartysprimaryelection, caucus, or convention.8. Race or Ethnic Group. Leaveblank.9. Signature. To vote in Missouriyoumust:isangmamamayanngEstadosUnidosbeacitizenoftheUnitedStatesbearesidentofMissouribeatleast171/2yearsofage(youmustbe18tovote)notbeonprobationorparoleaerconvictionofafelony,untilnallydischargedfromsuchprobation or parolenotbeconvictedofafelonyormisdemeanorconnectedwiththerightofsuragenotbeadjudgedincapacitatedbyany court o law

notbeconnedunderasentenceofimprisonment

Mailing address:Secretary o StateP.O.Box1767

JeersonCity,MO651021767

Montana

Updated: 03-01-2006


6. ID Number. Youmustprovideyour Montana driver's license

number.Ifyoudo not have aMontanadriver'slicensenumberthenyoumustlisttheLASTFOURDIGITSOFYOURSOCIALSECURITYNUMBER.Ifyouhave neither a driver's license, norasocialsecuritynumber,pleasewriteNONEontheform.estateofMontanawillassigntoyouauniqueidentifyingnumber.7. Choice of Party. Montana does

notrequirepartyregistrationtoparticipate in any election.8. Race or Ethnic Group.Leaveblank.9. Signature.ToregisterinMontanayoumust:beacitizenoftheUnitedStatesbeatleast18yearsoldonorbeore the electionbearesidentofMontanaandofthe county in which you want tovoteforatleast30daysbeforethenextelectionnotbeinapenalinstitutionforaelony convictionnotcurrentlybedeterminedbyacourttobeofunsoundmindmeetthesequalicationsbythenextelectiondayifyoudonotcurrentlymeetthem

Mailing address:Secretary o States OceP.O.Box202801State CapitolHelena,MT596202801

Nebraska

Updated: 03-01-2006

Registration Deadline ethirdFridaybeforetheelection(ordeliveredby6p.m.onthesecondFridaybeforetheelection)

6. ID Number. YoumustprovideyourNebraskadriver'slicense

number.Ifyoudo not have aNebraskadriver'slicensenumberthenyoumustlistthelastfourdigitsofyoursocialsecuritynumber.7. Choice of Party. Youmustregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection, caucus, or convention.8. Race or Ethnic Group.Leaveblank.

9. Signature. ToregisterinNebraskayoumust:beacitizenoftheUnitedStatesbearesidentofNebraskabeatleast18yearsofageorwillbe18yearsofageonorbeforetherstTuesdayaertherstMondayofNovembernothavebeenconvictedofaelony, or i convicted, have hadyourcivilrightsrestorednothavebeenociallyfoundtobementallyincompetent

Mailing address:NebraskaSecretaryofStateSuite2300,StateCapitolBldg. Lincoln,NE685094608


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State Instructions

Nevada

Updated: 05-07-2010

Registration Deadline edeadlineformailinregistration

isthehSaturdaybeforeanyprimaryorgeneralelection.Inpersonregistrationremainsavailableuntil9:00p.m.onthethirdTuesdayprecedinganyprimaryorgeneralelection.YoumayregistertovoteinpersononlybyappearingattheoceoftheCountyClerk/RegistrarofVoters.

6. ID Number. You must supply a

NevadasDriversLicenseNumberorNevadaIDCardNumberi youhave been issued one. I you do nothaveaDriversLicenseNumberorNevadaIDCardNumber,youmustsupplythelastfourdigitsofyourSocialSecurityNumber.Ifyou do not have a Social SecurityNumber,pleasecontactyourCountyClerk/RegistrarofVoterstobeassignedauniqueidentier.

7. Choice of Party.Youmustregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection, caucus, or convention. If

youregisterwithaminorpoliticalparty,orasaNonpartisanyouwillreceiveaNonpartisanBallotforthePrimaryElection.8. Race or Ethnic Group.Leaveblank.

9. Signature.ToregisterinNevadayoumust:beacitizenoftheUnitedStateshaveattainedtheageof18yearsonthedateofthenextelectionhavecontinuouslyresidedintheStateofNevada,inyourcounty,atleast 30 days and in your precinctatleast10daysbeforethenextelection

haveyourcivilrightsrestoredifyou were convicted o a elonynotbedeterminedbyacourtoflawtobementallyincompetentclaimnootherplaceasyourlegalresidence

Mailing address:Secretary o StateElectionsDivision101NorthCarsonStreetSuite 3CarsonCity,NV897014786

Applicationsmaybereturnedtothe Secretary o States ofce atthe address above, but to avoid

possible delays, you are advisedtoreturnyourcompletedvoterregistrationapplicationsdirectlytoyour local county election ofcial.

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 or their own absenteevotermailinregistrationform,whichmustbereceivedbyyourcity or town clerk by 10 days beorethe election.

NewHampshiretownandcityclerks will accept this applicationonly as a request or their ownabsenteevotermailinregistrationform.YouneedtollinonlyBox1andBox2or3.

eapplicationshouldbemailedto your town or city clerk at yourzipcode.eseaddressesarelisted on the Secretary o Stateweb site at http://www.state.nh.us/sos/clerks.htm

Itshouldbemailedinplentyoftimeforyourtownorcityclerktomailyoutheirownformandfor

youtoreturnthatformtothemby10 days beore the election.

New Jersey

Updated: 03-28-2008


6. ID Number. elastfourdigits

ofyourSocialSecuritynumberORyourNewJerseyDriver'sLicensenumberisrequiredforvoterregistration.Ifyoudonotpossesseitheroftheseidentications,pleasewrite"NONE"ontheform.eStatewillassignanumberthawill serve to identiy you or voterregistrationpurposes.7. Choice of Party. NewJersey'svoterregistrationformdoesnotprovideacheckoforpoliticalpartyaliation.Anewlyregisterevoter or voter who has never votedinapoliticalpartyprimaryelectiocan declare party afliation atthepollingplaceonthedayofaprimaryelection.InNewJersey,aprimaryelectionisonlyheldfortheDemocraticandRepublicanparties.Avotermayalsolea


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State Instructions

politicalpartydeclarationformtobecomeamemberofapoliticalparty. I a declared voter wishedtochangepartyaliationheorshemustleadeclarationform50daysbeforetheprimaryelection,

in order to vote.8. Race or Ethnic Group.Leaveblank.9. Signature.ToregisterinNewJerseyyoumust:beacitizenoftheUnitedStatesbeatleast18yearsofagebythetimeofthenextelectionbearesidentofthisStateandcounty at your address at least 30daysbeforethenextelection

notbeservingasentenceoronparole or probation as the resulto a conviction o any indictableoenseunderthelawsofthisoranother state or o the United States

Mailing address:NewJerseyDepartmentofLawand Public SaetyDivisionofElectionsPOBOX304Trenton,NJ086250304

New Mexico

Updated: 03-01-2006


6. ID Number. Your ull socialsecuritynumberisrequired.isregistrationcardcontainingyoursocialsecuritynumberwillbecomepartofthepermanentvoterregistrationrecordsofyour locality, which are opento inspection by the public inthe ofce o the county clerk.However, your social securitynumberanddateofbirthwillremaincondentialandwill

not be disclosed to the public.Computerizedlistingsoflimitedvoterregistrationinformation(withoutsocialsecuritynumberorbirthdate)areavailabletothegeneralpublic,andare

urnished upon request toincumbentelectionoceholders,candidates, political parties, courtsandnonprotorganizationspromotingvoterparticipationandregistration,forpoliticalpurposesonly(1519B,NMSA1978).7. Choice of Party. Youmustregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection, caucus, or convention.

8. Race or Ethnic Group. Leaveblank.9. Signature.ToregisterinNewMexicoyoumust:beacitizenoftheUnitedStatesbearesidentoftheStateofNewMexicobe18yearsofageatthetimeofthenextelectionnothavebeendeniedtherightto vote by a court o law by reasonofmentalincapacityand,ifIhave been convicted o a elony, Ihavecompletedallconditionsofprobation or parole, served theentirety o a sentence or have beengrantedapardonbytheGovernor.

Mailing address:BureauofElections325DonGaspar,Suite300 SantaFe,NM87503

New York

Updated: 03-01-2006


6. ID Number. Federallawrequiresthat you provide your drivers

licensenumbertoregistertovote.I you do not have a drivers licensethen you will have to provide at leasthelastfourdigitsofyoursocialsecuritynumber.IfyouhaveneitherpleasewriteNONEontheform.

AuniqueidentifyingnumberwillbassignedtoyoubyyourState.7. Choice of Party. Youmustenroll with a party i you wanttovoteinthatpartysprimaryelection or caucus.8. Race or Ethnic Group. Leaveblank.9. Signature.ToregisterinNewYorkyoumust:beacitizenoftheUnitedStates

bearesidentofthecounty,oroftheCityofNewYork,atleast30days beore an electionbe18yearsoldbyDecember31oftheyearinwhichyoulethisform(Note:Youmustbe18yearsoldbythedateofthegeneral,primary,orotherelectioninwhichyouwanttovote)notbeinjailoronparoleforaelony convictionnotcurrentlybejudgedincompetentbyorderofacourtofcompetentjudicialauthoritynotclaimtherighttovoteelsewhere

Mailing address:NYSBoardofElections40SteubenStreetAlbany,NY122072108

North Carolina

Updated: 03-01-2006

Registration Deadline Postmarked25daysbeforethe election or received in theelectionsoceordesignatedvoterregistrationagencysiteby5:00p.m25daysbeforetheelection.


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State Instructions

6. ID Number. ProvideyourNorthCarolinadriverslicensenumber,orNorthCarolinaDepartmentofMotorVehiclesIDnumber.Ifyou do not have a driver's license,thenlistthelastfourdigitsofyour

socialsecuritynumber.7. Choice of Party.Youmustregisterwithapartytovoteinthatpartysprimaryunlessthatpartyallows unafliated voters to voteinitsprimary.Ifyouindicateapoliticalpartythatisnotaqualiedparty, or indicate no party, you willbelistedasUnaliated.8. Race or Ethnic Group. Youarerequiredtollinthisbox.

However, your application willnot be rejected i you ail to do so.See the list o choices under theApplicationInstructionsforBox8(onpage2).9. Signature. ToregisterinNorthCarolinayoumust:beacitizenoftheUnitedStatesbearesidentofNorthCarolinaand the county in which you live orat least 30 days prior to the electionbe18yearsofagebythedayofthenextgeneralelectionhaveyourrightsofcitizenshiprestored i you have been convictedo a elonynotberegisteredorvoteinanyother 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.TisinformationallowstheBoardofElectionstoverifyyourregistrationifnecessary(O.R.C.3503.14).[Federallaw requires that you provide yourdriverslicensenumbertoregisterto vote. I you do not have a driverslicense then you will have to provide

atleastthelastfourdigitsofyoursocialsecuritynumber.IfyoudonthaveeithernumberyouwillhavetowriteNONEontheformandtheStatewillassignyouanumber.]7. Choice of Party. You do notregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection. Party afliation is establishedbyvotingataprimaryelection.8. Race or Ethnic Group. Leave

blank.9. Signature. ToregisterinOhioyoumust:beacitizenoftheUnitedStatesbearesidentofOhiobe18yearsoldonorbeforeelectionday.Ifyouwillbe18onorbeforethedayofthegeneralelection,youmayvoteintheprimaryelectionforcandidatesonly.notbeconvictedofafelonyandcurrently incarceratednotbefoundincompetentbyacourtforpurposesofvoting

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

Oklahoma

Updated: 10-29-2003


6. ID Number.elastfourdigitsofyoursocialsecuritynumberarerequired.(OklahomaTitle26,Section4112)Inaddition,your

Oklahomadriverslicensenumberis requested.7. Choice of Party.Youmustregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection, caucus, or convention.8. Race or Ethnic Group.Leaveblank.9. Signature.ToregisterinOklahomayoumust:beacitizenoftheUnitedStates

and a resident o the State oOklahomabe18yearsoldonorbeforethedateofthenextelectionhavenotbeenconvictedofafelony,forwhichaperiodoftimeequaltotheoriginalsentencehasnotexpired,orforwhichyouhavenot been pardonednotnowbeunderjudgmentasanincapacitated person, or a partiallyincapacitated person prohibitedfromregisteringtovote

Mailing address:OklahomaStateElectionBoardBox528800OklahomaCity,OK731528800


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State Instructions

Oregon

Updated: 03-01-2006


6. ID Number. Federallawrequiresthat you provide your driverslicensenumbertoregistertovote.I you do not have a drivers licensethen you will have to provide atleastthelastfourdigitsofyoursocialsecuritynumber.Ifyouhaveneither, you will need to writeNONEontheform.Auniqueidentifyingnumberwillinsteadbe

assignedtoyoubyyourState.7. Choice of Party. Youmustregisterwithapartyifyouwanttotakepartinthatpartysprimaryelection.8. Race or Ethnic Group.Leaveblank.9. Signature.ToregisterinOregonyoumust:beacitizenoftheUnitedStatesbearesidentofOregon

beatleast18yearsoldbyelection day

Mailing address:Secretary o StateElectionsDivision141StateCapitolSalem,OR973100722

Pennsylvania

Updated: 03-01-2006

Registration Deadline 30daysbeforeanelectionorprimary.

6. ID Number. YoumustsupplyaDriver'sLicenseNumber,ifyouhave one. I you do not have aDriver'sLicenseNumber,youmustsupply the lastfourdigits o your

socialSecurityNumber.IfyoudonothaveaSocialSecurityNumber,pleasewriteNONEinthebox.7. Choice of Party.Youmustregisterwith a party i you want to take partinthatpartysprimaryelection.

8. Race or Ethnic Group. Youarerequestedtollinthisbox.See the list o choices under theApplicationInstructionsforBox8(onpage2).9. Signature. ToregisterinPennsylvaniayoumust:beacitizenoftheUnitedStatesatleastonemonthbeforethenextelectionbearesidentofPennsylvaniaand

yourelectiondistrictatleast30days beore the electionbeatleast18yearsofageonthedayofthenextelection

Mailing address:Oce o the Secretary otheCommonwealth 210NorthOceBldg.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 caseo an applicant who has not beenissued a current and valid driver'slicensehe/shemustprovidethelastfour(4)digitsofhis/hersocialsecuritynumber.Anapplicant,whohasneither,willbeassignedauniqueidentifyingnumberbytheState o Rhode Island.

7. Choice of Party. In Rhode Islandapersonmustregisterwithapartyi he/she wishes to take part in thatparty'sprimaryelection.Apersonwhofailstoregisterwithapartyatthetimeofregistrationmay,ifhe/

shechooses,registerwithapartyonthedayofthatparty'sprimaryandtakepartinthatparty'sprimarelection. I a person does notregisterwithaparty,he/shecanstillvoteingeneralelectionsandnonpartisanprimaryelections.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinRhodeIslandyoumust:

beacitizenoftheUnitedStatesbearesidentofRhodeIslandfor30daysprecedingthenextelectionbe18yearsoldbyelectiondaynotbecurrentlyincarceratedinacorrectional acility due to a elonyconvictionnothavebeenlawfullyjudgedtobementallyincompetent

Mailing address:RhodeIslandStateBoardofElections50BranchAve.Providence,RI029042790

South Carolina

Updated: 03-01-2006


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


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State Instructions

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

8. Race or Ethnic Group. You arerequiredtollinthisbox.Yourapplicationmayberejectedifyouail to do so. See the list o choicesunder the Application InstructionsforBox8(onpage2).9. Signature.ToregisterinSouthCarolinayoumust:beacitizenoftheUnitedStatesbeatleast18yearsoldonorbeforethenextelection

bearesidentofSouthCarolina,your county and precinctnotbeconnedinanypublicprisonresultingfromaconvictionofacrimeneverhavebeenconvictedofafelonyoroenseagainsttheelection laws, or i previouslyconvicted, have served your entiresentence,includingprobationorparole, or have received a pardonor the convictionnotbeunderacourtorderdeclaringyoumentallyincompetentclaimtheaddressontheapplicationasyouronlylegalplaceofresidenceandclaimnootherplaceasyourlegalresidence

Mailing address:StateElectionCommissionP.O.Box5987

Columbia,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.Youmust

registerwithapartyifyouwanttotakepartinthatpartysprimaryelection, caucus, or convention.8. Race or Ethnic Group.Leaveblank.9. Signature.ToregisterinSouthDakotayoumust:beacitizenoftheUnitedStatesresideinSouthDakotabe18yearsoldbythenextelection

notbecurrentlyservingasentence or a elony convictionwhichincludedimprisonment,served or suspended, in an adultpenitentiarysystemnothavebeenadjudgedmentallyincompetentbyacourt

Mailing address:Elections, Secretary o 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:beacitizenoftheUnitedStatesbearesidentofTennesseebeatleast18yearsoldonorbeforethenextelection

nothavebeenconvictedofaelony, or i convicted, have hadyourfullrightsofcitizenshiprestored(orhavereceivedapardonnotbeadjudicatedincompetentbyacourtofcompetentjurisdiction (or have been restoredtolegalcapacity)

Mailing address:Coordinator o Elections

TennesseeTower,NinthFloor312EighthAvenue,NorthNashville,TN37243

Texas

Updated: 03-01-2006


6. ID Number.Youmustprovideyourdriverslicensenumbertoregistertovote.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:beacitizenoftheUnitedStates


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State Instructions

bearesidentofthecountyin which the application orregistrationismadebeatleast17yearsand10monthsold(youmustbe18tovote)notbenallyconvictedofa

elony, or i a convicted elon,youmusthavefullydischargedyourpunishment,includinganyincarceration, parole, supervision,period o probation or be pardoned.havenotbeendeclaredmentallyincompetentbynaljudgmentofacourt o law

Mailing address:Ofce o the Secretary o State

ElectionsDivisionP.O.Box12060Austin,TX787112060

Utah

Updated: 03-28-2008

Registration Deadline 30 daysbeforetheelectionformailinapplications;15daysbeforethe

electionforwalkinregistrationsatthe county clerks ofce.

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 afliate with a party,youmayberestrictedfromvotingintheprimary.

8. Race or Ethnic Group.Leaveblank.9. Signature. ToregisterinUtahyoumust:beacitizenoftheUnitedStateshaveresidedinUtahfor30daysimmediatelybeforethenextelectionbeatleast18yearsoldonorbeforethenextelectionnotbeaconvictedfeloncurrentlyincarceratedforcommissionofa

elonynotbeconvictedoftreasonorcrimeagainsttheelectiveranchise, unless restored to civilrightsnotbefoundtobementallyincompetentbyacourtoflaw

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.Toregisterin

Vermontyoumust:beacitizenoftheUnitedStatesbearesidentofVermontbe18yearsofageonorbeforeelection dayhavetakenthefollowingOath:Yousolemnlyswear(orarm)thatwheneveryougiveyourvoteorsurage,touchinganymatterthatconcernsthestateofVermont,youwilldoitsoasin

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

Mailing address:Ofce o the Secretary o StateDirectorofElections26 Terrace StreetMontpelier,VT056091101

Virginia

Updated: 11-10-2010

Registration Deadline Delivered29daysbeforetheelection.

6. ID Number. Your ull socialsecuritynumberisrequired.Yoursocialsecuritynumberwillappearon reports produced only orocialusebyvoterregistrationand election ofcials and, or juryselection purposes, by courts.


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State Instructions

Article II, 2, Constitution oVirginia(1971).7. Choice of Party. You do nothavetoregisterwithapartyifyouwant to take part in that partysprimaryelection,caucus,or

convention.8. Race or Ethnic Group. Leaveblank.9. Signature. ToregisterinVirginiayoumust:beacitizenoftheUnitedStatesbearesidentofVirginiaandoftheprecinct in which you want to votebe18yearsoldbythenextMayorNovembergeneral electionnothavebeenconvictedofa

felony,orhavehadyourcivilrightsrestorednotcurrentlybedeclaredmentallyincompetentbyacourtoflaw

Mailing address:StateBoardofElections1100 Bank Street, 1st Floor

Richmond,VA23219

Washington

Updated: 10-29-2003

Registration Deadline 30 daysbeore the election (or deliveredinpersontothelocalvoterregistrationoce15daysbeforetheelection).

6. ID Number. Youmustprovideyourdriver'slicensenumber.IfyoudonothaveaWashingtondriver'slicense,youmustprovidethelastfourdigitsofyourSocialSecurityNumber.Failuretoprovidethisinformationmaypreventyourregistrationfrombeingprocessed.7. Choice of Party. You are notrequiredtodesignateyourpartyaliationtoregisterinWashington.

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

State, your county and precinct or30daysimmediatelyprecedingtheelection in which you want to votebeatleast18yearsoldbyelectiondaynotbeconvictedofinfamouscrime,unlessrestoredtocivilrights

Mailing address:Secretary o State

VoterRegistrationbyMailP.O.Box40230Olympia,WA985040230

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

liveinWestVirginiaattheaboveaddressbe18yearsold,ortovoteintheprimarybe17yearsoldandturning18beforethegeneralelection

notbeunderconviction,probation, or parole or a elony,treason or election briberynothavebeenjudgedmentallyincompetentinacourtofcompetentjurisdiction

Mailing address:Secretary o StateBuilding1,Suite157K 1900KanawhaBlvd.East

Charleston,WV253050770

Wisconsin

Updated: 09-12-2006

Registration Deadline Twenty(20)daysbeforetheelection(orcompletedinthelocalvoterregistrationoceupto5:00pm.1daybeforetheelection,orcompleted

atthepollingplaceonelectionday).

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:beacitizenoftheUnitedStatesbearesidentofWisconsinforatleast 10 daysbe18yearsoldnothavebeenconvictedoftreason, elony or bribery, or i youhave,yourcivilrightshavebeenrestored


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State Instructions

nothavebeenfoundbyacourttobeincapableofunderstandingtheobjective o the electoral processnotmakeorbenetfromabetorwagedependingontheresultofanelection

nothavevotedatanyotherlocation,ifregisteringonelectionday

Mailing address:StateElectionsBoard17WestMainStreet,Suite310P.O.Box2973Madison,WI537012973

Wyoming

Updated: 03-01-2006

Wyomingbylaw,cannotacceptthisformunlessStatelawischanged.

national mail voter registration form english february 15 2011

Documents