Fillable Form 1.: Virginia Voter Registration Application (City of Colonial Heights, VA)

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Form 1.: Virginia Voter Registration Application (City of Colonial Heights, VA)

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The Form 1.: Virginia Voter Registration Application (City of Colonial Heights, VA) form is 2 pages long and contains:

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  • 19 check-boxes
  • 45 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Colonial Heights, VA

BROWSE CITY OF COLONIAL HEIGHTS, VA (VA) FORMS

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VA-NVRA-1 07/2020
Starred (*) items are required. If you do not complete all of the items that are marked with *, your application may be denied (See instructions on reverse side).
Virginia Voter Registration Application
AFFIRMATION: I swear/affirm, under felony penalty for making willfully false material statements or entries, that the information provided
on this form is true. I authorize the cancellation of my current registration and I have read the Privacy Act Notice.
By checking this box, I arm both that I am an individual with physical disabilities and the Armation Statement above. Pursuant to
Article II, § 2 of the Constitution of Virginia, individuals with physical disabilities are not required to sign the application for voter registrations.
*
Signature
*
Virginia Voter Registration Application Receipt
#
The application collector must submit your
completed application within 10 days or by the
deadline to register for the next election, whichever
comes first. You can check your voter registration
status online at www.elections.virginia.gov/registration.
If you do not receive confirmation of your voter
registration status within 30 days, contact your local
voter registrar or the Virginia Department of Elections.
YES NO
*
Have you ever been convicted of a felony or
judged mentally incapacitated and disqualied to vote? ......... YES NO
If YES, has your right to vote been restored?
.......
YES NO
*
Full social
security
number
*
I am a citizen of the
United States of America.
Name, phone and e-mail of oce, group or individual
receiving application
An active or retired law enforcement officer, judge, U.S. or Virginia Attorney General attorney.
Been granted a court issued protective order.
In fear for personal safety from being threatened or stalked by another person.
A participant in the Virginia Attorney General’s Address Confidentiality Program.
Been approved to be a foster parent.
6.
I am interested in being an Ocer of Election (poll worker) on Election Day. Please send me information.
Use blue or black ink
*
Date of
birth
/ /
D D
MM
Y YY
Y
D D
MM
Y YY
Y
Today’s date:
/ /
D D
MM
Y YY
Y
Date application received
/ /
D D
MM
Y YY
Y
7.
Thank you for applying
to vote in Virginia!
*
Gender
3.
I am an active-duty uniformed services member, spouse or dependent; or an overseas citizen.
I am providing a mailing address (below) because my residence address is not serviced by the U.S. Postal Service or I am homeless.
I am providing a Virginia P.O. Box (below) to protect my residence address from public disclosure because I or a household member is/has:
4.
*
Residence address (May not be a P.O. Box)
*
City/Town
Apt #
*
Last name
*
First name
2.
Jr. Sr. II III IV (Circle if applicable)
*
ZIP
E-mail
*
Middle name
N
-
-
Phone
N N
N N N
N N
N
NN
None
-
-
NNNN
N
N
NNN
No SSN was ever issued.
5.
My mailing address (Complete only if you have checked a box in this section)
I am currently registered to vote in another state: .
(
Indicate state of previous registration)
1.
VA-NVRA-1 07/2020
Virginia Voter Registration Application
When registering to vote, Article II, Section 2 of the Constitution of Virginia (1971) requires you to provide your social
security number, if you have one. If you do not provide your social security number, your application will be denied.
Voting ocials use the social security number as a unique identier to ensure that no voter is registered in more than
one place.
Your application will only be open to inspection by the public if the social security number is removed. Your social
security number will appear on reports produced only for ocial use by voter registration and election ocials, for
jury selection purposes by courts, and all lawful purposes. Your decision to decline to register to vote as well as the
oce where you submit your application, if you choose to do so, are condential and will only be used for voter
registration purposes.
With this form, you can register to vote in elections in Virginia. You can also use this form to change the information
on your Virginia voter registration.
If you are currently registered to vote, you do not have to use this form unless you have moved or changed your
name.
ATTENTION: Overseas citizens, uniformed service voters, qualifying spouses and dependents may register using the
Federal Post Card Application (FPCA), available at www.fvap.gov.
Register to
Vote
Your Address
How to Mail
Mail your completed application to your local registrar. Use the online address lookup tool if you do not know
your registrar’s address: www.elections.virginia.gov/localGR or mail your application to:
Virginia Department of Elections
1100 Bank Street
Richmond, VA 23219
Mailed applications must be postmarked at least 22 days before the next election in which you plan to vote. A
qualied active-duty uniformed services member, spouse or dependent is NOT subject to the mailing deadline if by
reason of active duty, you are normally absent from the locality in which you reside.
#
WARNING: INTENTIONALLY VOTING MORE THAN ONCE IN AN ELECTION OR MAKING A MATERIALLY FALSE
STATEMENT ON THIS FORM CONSTITUTES THE CRIME OF ELECTION FRAUD, WHICH IS PUNISHABLE UNDER
VIRGINIA LAW AS A FELONY
. VIOLATORS MAY BE SENTENCED TO UP TO 10 YEARS IN PRISON, OR
UP TO 12 MONTHS IN JAIL AND/OR FINED UP TO $2,500.
ID
Requirements
Privacy Act
Notice
You may complete your voter registration application online at www.elections.virginia.gov/registration. You may
also check your voter registration status online at www.elections.virginia.gov/registration.
Go Online
Call your local voter registration oce or call (800) 552-9745 • TTY 711.
Questions?
All voters must show one acceptable form of ID or provide a written statement when voting in-person. In federal
elections, all first time voters who registered by mail will be required to provide one acceptable form of ID; a
written statement will not be accepted.
For a complete list of acceptable forms of ID visit: www.elections.virginia.gov/voterID.
Need more information? Go Online: www.elections.virginia.gov Or Call: (800) 552-9745 TTY: 711
You must provide a street address or a description of where you live as a residence address. You may provide a mail-
ing address in Box 4 if: (1) your residence address is not serviced by the U.S. Postal Service; (2) you are homeless;
(3) you are an overseas citizen; or (4) you are a uniformed service member, or qualifying spouse or dependent.
Qualied protected voters must provide a Virginia post oce box in Box 4 to receive protected voter status. No
other applicant can list a mailing address.
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Form 1.: Virginia Voter Registration Application (City of Colonial Heights, VA)

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Completed 22 January 2021

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