Kansas Voter Registration Instructions
For further information, contact the Ofce of the Secretary of State,
1-800-262-VOTE (8683) V/TTY. This form is available at www.sos.ks.gov.
You can use this application to:
register to vote in Kansas
change your name, address, or afliation with a political party
To register to vote, you must:
be a U.S. citizen and a resident of the state of Kansas.
have reached the age of 18 years before the next election.
have received nal discharge from imprisonment, parole, or condi-
tional release if convicted of a felony.
have abandoned your former residence and/or name.
How to register to vote:
Return your completed application to your county. Addresses are on
the back of this application. Your county election ofcer will mail you a
notice when your application has been processed.
Voter registration closes 21 days before any election. In order to be
eligible to vote in that election, your application must be postmarked
on or before that date.
If you decline to register to vote, that fact will remain condential and
will be used for voter registration purposes only. If you do register to
vote, the ofce where you apply will be kept condential and will be
used for voter registration purposes only.
If this form is incomplete, it may be rejected.
Identication number requirements
Enter your current Kansas driver’s license number or nondriver’s identica-
tion card number. If you do not have either one, enter the last four digits
of your Social Security number. If you do not have any of these numbers,
write “none” in the box. The number will be used for administrative pur-
poses only and will not be disclosed to the public. K.S.A. 25-2309
Proof of U.S. citizenship
If you are registering for the rst time in Kansas, you must submit
proof of United States citizenship. You may provide a copy on paper or
electronically, or you may show the document to an election ofcer or
ofcial registrar. The following is a partial list of acceptable documents:
Birth certicate that veries U.S. citizenship
U.S. passport (may be expired)
U.S. naturalization documents or the number of the certicate of
naturalization
Bureau of Indian Affairs card number, tribal treaty number or tribal
enrollment number
U.S. hospital record of birth indicating place of birth in the U.S.
U.S. military record of service showing the applicant’s name and U.S.
birthplace
For a list of acceptable documents, visit http://www.gotvoterid.com. If you do not have any
of the documents, you may appeal to the state election board.
Rev. 5/3/16 tc
Kansas Voter Registration Application
Warning: If you submit a false voter registration application,
you may be convicted and sentenced to up to 17 months in prison.
Qualications: If you mark “no” in response to either Question 1 or 2, do not complete this form.
1. Are you a citizen of the United States of America?
Yes
No
2. Will you be 18 years of age on or before Election Day?
Yes
No
Last Name (please print) First Name Middle Jr. Sr. II III
Male
Female
Residential Address (include apt. or space number) City County Zip
Mailing Address (if different than residential address) City Zip Date Residence Established (MM/DD/YY)
Birth Date (MM/DD/YY) Daytime Phone Number (if available) Naturalization Number (if applicable) Driver’s License Number or Last 4 Social Security (see instructions)
Party Afliation: Choose one of the following:
Democratic
Republican
Libertarian
Not afliated with a party
Complete if previously
registered (please print)
Previous Name Previous Residential Address (Street, City, State, Zip, County)
Signature: I swear or afrm that I am a citizen of the United States and a Kansas resident, that I will be 18 years old before the next election, that if convicted of a felony, I
have had my civil rights restored, that I have abandoned my former residence and/or other name, and that I have told the truth on this application.
Signature Date (MM/DD/YY)
For ofce use only: Ward ______________________ Pct. ______________________ School Dist. ______________________ Member Dist. ______________________
Sen. ________________ Rep. ________________ CoComm ________________ Section ________________ Township ________________ Range _________________
Print in blue or black ink, fold on the center line, seal, and return.
è
Please complete the form, print, sign and mail to your county election officer. Selecting 'Print' will print the form and
'Reset' will clear the entire form.
Print
Reset
Allen County
1 N. Washington
Iola, KS 66749
Coffey County
110 S. 6th St Rm 202
Burlington, KS 66839
Geary County
200 E. 8th St
Junction City, KS 66441
Johnson County
2101 E. Kansas City Rd
Olathe, KS 66061
Miami County
201 S. Pearl Ste 102
Paola, KS 66071
Pratt County
300 S. Ninnescah / Box 885
Pratt, KS 67124
Sherman County
813 Broadway Rm 102
Goodland, KS 67735
Anderson County
100 E. 4th
Garnett, KS 66032
Comanche County
201 S. New York / Box 776
Coldwater, KS 67029
Gove County
P.O. Box 128
Gove, KS 67736
Kearny County
304 N. Main / Box 86
Lakin, KS 67860
Mitchell County
111 S. Hersey / Box 190
Beloit, KS 67420
Rawlins County
607 Main
Atwood, KS 67730
Smith County
218 S. Grant
Smith Center, KS 66967
Atchison County
423 N. 5th
Atchison, KS 66002
Cowley County
321 E. 10th Ave.
Wineld, KS 67156
Graham County
410 N. Pomeroy
Hill City, KS 67642
Kingman County
130 N. Spruce
Kingman, KS 67068
Montgomery County
217 E. Myrtle / Box 446
Independence, KS 67301
Reno County
206 W. First
Hutchinson, KS 67501
Stafford County
209 N. Broadway
St John, KS 67576
Barber County
120 E. Washington
Medicine Lodge, KS 67104
Crawford County
111 E. Forest / Box 249
Girard, KS 66743-0249
Grant County
108 S. Glenn
Ulysses, KS 67880
Kiowa County
211 E. Florida
Greensburg, KS 67054
Morris County
501 W. Main
Council Grove, KS 66846
Republic County
1815 M. Street
Belleville, KS 66935
Stanton County
201 N. Main / Box 190
Johnson, KS 67855
Barton County
1400 Main Rm 202
Great Bend, KS 67530
Decatur County
P.O. Box 28
Oberlin, KS 67749
Gray County
P.O. Box 487
Cimarron, KS 67835
Labette County
501 Merchant / Box 387
Oswego, KS 67356
Morton County
1025 Morton / Box 1116
Elkhart, KS 67950
Rice County
101 W. Commercial
Lyons, KS 67554
Stevens County
200 E. 6th
Hugoton, KS 67951
Bourbon County
210 S. National
Fort Scott, KS 66701
Dickinson County
109 E. First / Box 248
Abilene, KS 67410
Greeley County
P.O. Box 277
Tribune, KS 67879
Lane County
144 S. Lane / Box 788
Dighton, KS 67839
Nemaha County
607 Nemaha / Box 186
Seneca, KS 66538
Riley County
110 Courthouse Plaza
Manhattan, KS 66502
Sumner County
501 N. Washington
Wellington, KS 67152
Brown County
601 Oregon St
Hiawatha, KS 66434
Doniphan County
P.O. Box 278
Troy, KS 66087
Greenwood County
311 N. Main
Eureka, KS 67045
Leavenworth County
300 Walnut
Leavenworth, KS 66048
Neosho County
100 S. Main / Box 138
Erie, KS 66733
Rooks County
115 N. Walnut
Stockton, KS 67669
Thomas County
300 N. Court Ave
Colby, KS 67701
Butler County
205 W. Central
El Dorado, KS 67042
Douglas County
1100 Massachusetts St
Lawrence, KS 66044
Hamilton County
219 N. Main / Box 1167
Syracuse, KS 67878
Lincoln County
216 E. Lincoln Ave
Lincoln, KS 67455
Ness County
202 W. Sycamore
Ness City, KS 67560
Rush County
715 Elm / Box 220
LaCrosse, KS 67548
Trego County
216 Main
WaKeeney, KS 67672
Chase County
Courthouse Sq / Box 529
Cottonwood Falls, KS 66845
Edwards County
312 Massachusetts St
Kinsley, KS 67547
Harper County
201 N. Jennings
Anthony, KS 67003
Linn County
P.O. Box 350
Mound City, KS 66056
Norton County
105 S. Kansas / Box 70
Norton, KS 67654
Russell County
4th & Main / Box 113
Russell, KS 67665
Wabaunsee County
215 Kansas / Box 278
Alma, KS 66401
Chautauqua County
215 N. Chautauqua
Sedan, KS 67361
Elk County
127 N. Pine / Box 606
Howard, KS 67349
Harvey County
8th & Main / Box 687
Newton, KS 67114
Logan County
710 W. 2nd
Oakley, KS 67748
Osage County
717 Topeka Ave / Box 226
Lyndon, KS 66451-0226
Saline County
300 W. Ash / Box 5040
Salina, KS 67402
Wallace County
P.O. Box 70
Sharon Springs, KS 67758
Cherokee County
110 W. Maple / Box 14
Columbus, KS 66725
Ellis County
P.O. Box 720
Hays, KS 67601
Haskell County
300 Inman / Box 518
Sublette, KS 67877
Lyon County
430 Commercial
Emporia, KS 66801
Osborne County
423 W. Main / Box 160
Osborne, KS 67473
Scott County
303 Court St
Scott City, KS 67871
Washington County
214 C St
Washington, KS 66968
Cheyenne County
212 E. Wash. / Box 985
St Francis, KS 67756
Ellsworth County
210 N. Kansas
Ellsworth, KS 67439
Hodgeman County
500 Main
Jetmore, KS 67854
Marion County
200 S. Third, Suite 104
Marion, KS 66861
Ottawa County
307 N. Concord Ste 130
Minneapolis, KS 67467
Sedgwick County
510 N. Main
Wichita, KS 67203-3798
Wichita County
206 S. 4th Drawer 968
Leoti, KS 67861
Clark County
913 Highland St / Box 886
Ashland, KS 67831-0886
Finney County
311 N. 9th St., Box M
Garden City, KS 67846
Jackson County
400 New York
Holton, KS 66436
Marshall County
1201 Broadway
Marysville, KS 66508
Pawnee County
715 Broadway
Larned, KS 67550
Seward County
515 N. Washington Ste 100
Liberal, KS 67901
Wilson County
615 Madison
Fredonia, KS 66736
Clay County
712 Fifth, Suite 102
Clay Center, KS 67432
Ford County
100 Gunsmoke
Dodge City, KS 67801
Jefferson County
P.O. Box 321
Oskaloosa, KS 66066
McPherson County
117 N. Maple
McPherson, KS 67460
Phillips County
301 State St
Phillipsburg, KS 67661
Shawnee County
3420 SW Van Buren
Topeka, KS 66611
Woodson County
105 W. Rutledge Rm 103
Yates Center, KS 66783
Cloud County
811 Washington
Concordia, KS 66901
Franklin County
315 S. Main
Ottawa, KS 66067
Jewell County
307 N. Commercial
Mankato, KS 66956
Meade County
P.O. Box 278
Meade, KS 67864
Pottawatomie County
207 N. 1st / Box 187
Westmoreland, KS 66549
Sheridan County
925 9th St / Box 899
Hoxie, KS 67740
Wyandotte County
850 State Ave
Kansas City, KS 66101
Kris W. Kobach, secretary of state
Memorial Hall, 1st Floor
120 S.W. 10th Avenue
Topeka, KS 66612-1594
Post Ofce
Will Not
Deliver
Without
Postage
County Election Ofcer
County
, KS
Please choose a county from the drop down list below.
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