Fillable Form 3.: Voter Registration Form IOWA (Drake University)

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Form 3.: Voter Registration Form IOWA (Drake University)

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The Form 3.: Voter Registration Form IOWA (Drake University) form is 1 page long and contains:

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  • 1 check-box
  • 50 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Drake University

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If you DO NOT have a street address because you use a rural route address or you are homeless, describe where you live.
City
State
ZIP
Description
(include Township and Section Number if known)
If mail CANNOT be delivered to the address above, provide an alternate mailing address.
Alternate Mailing Address
(include P.O. Box if applicable)
READ and SIGN
I swear or afrm that:
● I am the person named above.
● I am a citizen of the United States.
● I am at least 17 ½ years old.
● I live at the address listed above.
● I am not currently judged by a court to be “incompetent to vote”.
● I do not claim the right to vote anywhere else.
● I have not been convicted of a felony (or have received a restoration of rights).
Are you a citizen of the United States of America? Yes No
Will you be 18 years of age on or before Election Day? Yes No
If you checked NO in response to either of these questions, DO NOT complete this form.
X
_______________________________________________ ________________
Signature
Date
Daytime Phone (optional)
E-mail (optional)
( ) Year
Male
Female
SexDate of Birth
(Month/Day/Year)
/ / Year
A
Your Address Then
PREVIOUS REGISTRATION
(If you have ever been registered to vote before, complete this section.)
Your Name Then
Street Address
(include apt., lot, etc., if applicable)
City
ZIP
Iowa County Where You Live
State
You are required by law to provide your current and valid Iowa driver’s license or Iowa non-operator ID number.
If you do not have an Iowa driver’s license/non-operator ID number, provide the last 4 digits of your Social Security Number.
Valid IA Driver’s License or IA Non-Operator ID Number
Last 4 Digits of Social Security Number
Check this box only if you DO NOT have a current and valid Iowa driver’s license/ID OR a Social Security Number.
Check Only
ONE
Box
1.
2.
3.
7.
5.
6.
4.
Political Afliation
NOTE:
If you leave this
section blank,your
registration will be
listed as “No Party”.
Green
Libertarian
Democratic
Republican
No Party
Parties: Non-Party Political Organizations:
City
ZIP
County
State
Name
Last Name First Name Middle Name Sufx ( Sr., Jr., etc.)
Revised
01/01/08
Ofcial
IOWA
Voter Registration Form
B
WARNING:
If you sign this
form and you know
it is not true, you
can be convicted
of perjury and
ned up to $7,500
and/or jailed for up
to 5 years.
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Form 3.: Voter Registration Form IOWA (Drake University)

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Completed 21 November 2020

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