11-1400 (10/20)
MCA 61-5-107 and USC 666(a)(13)
OTHER SERVICES OFFERED:
If you are 15 or older, do you want your driver license or ID to show that you are an organ donor?
If you are 18 or older, do you want your driver license or ID to show that you have a living will?
If you are under age 26 but at least age 15, do you consent to registration with the Selective
Service System, if required by federal law? (If under 18, you will be registered upon attaining
age 18). >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
I certify under penalty of law that the information I provided is true and correct, except for my answer about sex,
to the best of my knowledge, information, and belief. I understand that any false or misleading statement on my
application may result in criminal prosecution, cancellation of any license or card issued and/or my disqualication
for a period of 60 days. I understand information may be veried against nationwide systems. I understand that if
Montana issues me a driver license or ID, any other card held in another state will be canceled. I understand that if
I am issued any other driver license or ID by any other state Montana will cancel all driver licenses or IDs issued by
Montana.
Signature: Date
VOTER REGISTRATION:
I want to register to vote or update my voter registration (continue on with application if selected)
I Do not want to register to vote (end of application if selected)
I’m already registered to vote and do not want to update my information (end of application if selected)
County you are residing in:
Are you a citizen of the United States? >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
Will you be at least 18 years of age on or before the next election? >>>>>>>>>>>>>>
Will you be a Montana resident for at least 30 days before the next election? >>>>>>>>
If you checked “No” in response to any of these questions, this is the end of the application.
Previous Registration Information - will be used to provide cancellation information to former jurisdiction.
Required if name changed or if previously registered to vote in another MT county or in another state.
Previous Registration Name Residence Address of previous registration
Previous City Previous County Previous State Previous Zip Code
Receive Your Ballot in the Mail
Yes, I request an absentee ballot to be mailed to me for all elections in which I am eligible to vote as long as I
reside at the address listed on this application. I understand that if I le a change of address with the U.S. Postal
Service, I must complete, sign, and return a conrmation notice mailed to me by the county election oce.
Voter Application Armation
I arm under penalty of perjury that the information on this application is true, that I am a citizen of the United
States, that I will be at least 18 years old on or before the next election, that I will have been a resident of Montana
for at least 30 days prior to the next election, and that I am not serving a felony conviction in a penal institution nor
have been found to be of unsound mind by a court. I understand that if I have given false information on this
application, I may be subject to a ne or imprisonment, or both, under federal and/or state law. By signing you
authorize the Motor Vehicle Division to use your electronic signature for voter registration purposes.
Signature Date
The armation on this application for voter registration must be signed by the applicant. Failure to do so will prevent
the application from being processed.
Where you submit this form and your decision to not vote is condential, and this information can only be used for
voter registration purposes.
You can visit the Montana Secretary of State “My Voter Page” to check if you are registered to vote, check your voter
registration address, and nd the location and directions to your polling place at: https://app.mt.gov/voterinfo/
Yes No
Yes No
Yes No Not Applicable
Yes No
Yes No
Yes No
