Fillable Form 1: (City of Harrisburg)

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Form 1: (City of Harrisburg)

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The Form 1: (City of Harrisburg) form is 1 page long and contains:

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  • 6 check-boxes
  • 34 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Harrisburg

BROWSE CITY OF HARRISBURG (SD) FORMS

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Auditor use only. Agency code:
2019
Use this form to: Register to vote or report a name, address, or party change.
Please print. Complete the entire form. Return this form to your county auditor.
The deadline for voter registration is 15 days before any election. Your form must be received by the county auditor by this deadline if you
are to
vote in the next election. Within 15 days you will receive a notice of your registration. If you do not, contact your county auditor. Any
private person
or entity registering voters is required to provide you with their contact information. For more information, visit www.sdsos.gov.
Are you a citizen of the United States of America?
Yes
No
Will you be 18 years of age on or before the next election?
Yes
If you checked 'No' in response to either of these questions, do not complete this form.
1
Last Name
First Name
Middle Name(s)/Initial
Suffix
2
Residence Address
Apt. or Lot #
City
State
Zip Code
3
Mailing Address (if different)
City
State
Zip Code
3a
If Residence Address is a PO Box, rural box, or general delivery, you must give the location of your residence:
4
Date of Birth (Required):
Month / Day / Year
5
Telephone Number
6
South Dakota Driver License Number (Required)
f d h S i i
7
Choice of Party – See information in
the box below:
8
Email Address
If you do not have a current SD Driver License,
provide the last 4 digits of Social Security Number
Choice of Party Information: If you are currently registered to vote and you leave the choice of party field blank, you will remain registered with your
current party affiliation. If you are not currently registered to vote and you leave the choice of party field blank, you will be entered as an
independent/no party affiliation voter, which is not a political party in South Dakota.
Previous Voter Registration Information Required Below. Use this section to cancel your previous voter registration:
9
Previous Last Name
First Name
Middle Name(s)
Suffix
10
Previous Address
City
State
Zip Code
11
Previous Driver License Number and State
Previous County
Date of Birth (Required)
Would you like to be a precinct election worker on election day?
Yes
No
12
I declare, under penalty of perjury (2 years imprisonment and
$4,000 fine), that:
*I am a citizen of the United States of America;
*I actually live at and have no present intention of leaving the above address;
*I will be 18 on or before the next election;
*I have not been judged mentally incompetent;
Signature Required
*I am not currently serving a sentence for a felony conviction; and
*I authorize cancellation of my previous registration, if applicable.
Date:
/_ /_
Month / Day / Year
South Dakota Voter Registration Form
____________________County
Select County
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Form 1: (City of Harrisburg)

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Completed 3 August 2020

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