Falsication of information on this form is punishable under Wisconsin law as a Class I felony
Prior Registration
Your Name
About You
phone number and email are
Your Mailing
if dierent from above
(check the box that applies to you)
WI Driver License or ID number
required if unexpired and valid.
SSN required if DL/ID not valid or
never issued
Signature and
Voter Signature
Assistant Signature
This Section for Ocial Use Only
Submitted by Mail
Ocial’s Signature
Ward Sch. District Alder Cty. Supr. Ct. Of App. Assembly St. Senate Congress
Condential Elector ID #
WisVote ID #
Wisconsin Voter Registration Application
Assistant Address
Sux (Jr., II, etc.)
Street Address (or P.O. Box)
Are a citizen of the United States
Will be at least 18 years old on or before Election Day
Are not currently serving a sentence including
incarceration, parole, probation, or extended
supervision for a felony conviction
Have resided at the address provided below for at least
28 consecutive days prior to the election and do not
currently intend to move
Proof of Residence
Examples include: a copy of a valid and unexpired Wisconsin Driver License or ID Card, a utility bill, a paycheck/pay stub,
or correspondence from a unit of government (see back of application for additional information and examples)
If you cannot check every box, do NOT complete this form
please check each box if
complete this eld if you are
updating your registration due to a
change in name or address
Proof of Residence Type
if someone assisted you by signing this
form, they must complete this section
Phone Number
Email Address
( )
Today’s Date
Date of Birth
/ /
Provide the last four digits of your Social Security Number
I do not have a valid WI Driver License or WI DOT issued ID
I have neither a valid WI Driver License/ID nor a Social Security Number (see back for more information and next steps)
Date Complete/POR ReceivedProof of Residence Issuing Entity Proof of Residence # Election Day Voter Number
/ /
I have an unexpired and valid WI Driver License or WI DOT issued ID. Provide number and expiration date below
Expiration Date
/ /
Full Name on Previous Registration
Full Address on Previous Registration (if known)
Voters must provide a proof of residence document when registering to vote. Please check this box to arm that you
are providing a copy of a valid form of proof of residence with this application
military and permanent overseas
voters are not required to provide
proof of residence
/ /
By signing below, I hereby certify that, to the best of my knowledge, I am a qualied elector, having resided at the above
residential address for at least 28 consecutive days immediately preceding this election, that I have no present intent to move,
and I have not voted in this election. I also certify that I am not otherwise disqualied from voting and that all statements on
this form are true and correct. If I have provided false information, I may be subject to ne or imprisonment under State and
Federal laws
REV 2020-06)
Please complete legibly
Additional instructions on reverse
Please return your completed form to
your municipal clerk
City/Town/Village of
Are you military or permanent overseas voter?
Military Permanent Overseas
Street Address Apt/Room #
Mailing Municipality
(if dierent)
The Address
Where You Live
your residential voting address,
which cannot be a P.O. Box
if you do not have a street address,
please use the map on the back of
this form
A WI Driver License/ID Card, if not expired or canceled; may be used even if driving privileges have been revoked
Any other ocial identication card or license issued by a Wisconsin governmental body or unit
An employee ID card with a photograph, but not a business card
A real property tax bill or receipt for the current year or the year preceding the date of the election
A residential lease (does not count as proof of residence if elector submits form by mail)
A picture ID from a university, college or technical college coupled with a fee receipt or an on-campus housing listing
provided by the university, college or technical college
A utility bill for the period commencing not earlier than 90 days before the day registration is made
(Homeless voters only) A letter from an organization that provides services to the homeless that identies the voter and
describes the location designated as the person’s residence for voting purposes
A contract/intake document prepared by a residential care facility indicating that the occupant resides in the facility
A bank/credit card statement
A paycheck or pay stub
A check or other document issued by a unit of government
If you do not have a street number or address, please use
this map to show where you live.
If you are a homeless voter and are registering to vote,
please also provide a letter from an organization that
provides services to the homeless that:
Lists your name
Describes the location designated as your residence for
voting purposes
If you did not check every box in this section, you are not eligible to vote in Wisconsin. Do not complete this form.
Provide your current and complete name. Please provide your name as it appears on your WI driver license or state-issued
ID card (Box 7), if applicable, and the proof of residence document you provided in Box 8.
Provide your month, day, and year of birth.
Providing your phone number and/or email address is optional and is subject to open records requests. This information
may be used by your municipal clerk to contact you about your voter record or absentee ballot request.
Provide your home address (legal voting residence) in Wisconsin.
Provide your full street name, including the type (St, Ave, etc.) and any pre- and/or post-directional (N, S, etc.).
You may not enter a PO Box as a residential address. A rural route box without a number should not be used.
A “military elector” is a person, or the spouse or dependent of a person who is a member of a uniformed service or merchant
marine, a civilian ocially attached to a uniformed service and serving outside the United States, or a Peace Corp volunteer.
Military electors are not required to register as a prerequisite to voting at any election.
A “permanent overseas elector” is a US citizen, at least 18 years old, who does not qualify as a resident of this state, but
who either last lived in this state, or whose parent last lived in this state immediately prior to the parent’s departure from the
United States, and who is not registered to vote in any other state.
If your mailing address is dierent from your home address, provide it here. A PO Box is acceptable as a mailing address.
Overseas electors should provide their complete overseas address here.
Provide full previous name if changed and/or previous address if you have been registered to vote anywhere in the U.S.
If you have a valid and unexpired WI driver license or WI DOT ID: provide that number. If you do not know your number,
please call (608) 266-2353 to get it.
If you have an expired, canceled, suspended, or revoked WI driver license or WI DOT ID: you must provide the last four
digits of your Social Security number. In addition, you may also provide the number on your license or ID (optional).
If you have never been issued a WI driver license or WI DOT ID: provide the last four digits of your Social Security number.
If you do not have a WI driver license or WI DOT ID nor a Social Security Number: please check the appropriate box.
If you are registering to vote on Election Day and have been issued a WI driver license or ID, but are unable or unwilling to
provide the number, your vote will not be counted unless you provide the number to the election inspectors by 8:00 p.m. on
Election Day or to your municipal clerk by 4:00 p.m. the Friday following Election Day.
Assistant: If you are unable to sign this form due to a physical disability, you may have an assistant do so on your behalf. That
assistant must provide his or her signature and address in the space provided. By signing, the assistant certies that he or she
signed the form at your request.
High School
Marmoset Drive
Do you need any accommodations at your polling place (e.g., curbside voting)? If so, please describe:
Please indicate if you are interested in
being a poll worker
Proof of residence documents may be provided in an
electronic format.
All proof of residence documents must contain voters current name and address.