ELIGIBILITY REQUIREMENTS AND
IDENTIFYING
INFORMATION
NOTE: VOTER REGISTRATION REQUIRES U.S. CITIZENSHIP
1 Check all that apply: New Registration Name Change Address Change Signature Update Other
Are you a citizen of the United
States?*
Yes
No
Will you be at least 18 years of age on or before the next
election?*
Yes
No
Will you be a Montana resident for at least 30 days before the next election?* Yes No
*If you checked “No” in response to any of these questions, do not complete this form.
Last Name*
(Jr., Sr., Etc.
4 Date of Birth*
_________/________ /________
month day year
Contact Phone Number Email Address
5 Select one of the following and provide the required information*
I have a Montana Driver’s License or Montana ID and that number
is
BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
I
do not have a Montana Driver’s License or MT ID card. The last 4 digits of my
SSN
are
BBBBBBBB
I
do not have a Montana Driver’s License or MT ID card, or a Social Security Number. I have attached a copy of a
photo ID that shows my name, or acceptable ID that shows my name and current address
(paycheck
stub; utility bill;
bank
statement;
or government document).
ID numbers provided above are kept confidential and are not available for public inspection.
6 Montana Residence Address*
City* County* Zip Code*
Mailing Address (required if differs from residence address)
If applicable, check one of the following:
Military Domestic (or military spouse or dependent) – only if on active duty and will be absent from place of registration
Military Overseas (or overseas military spouse or dependent) U.S. Citizen Overseas
PREVIOUS REGISTRATION INFORMATION – will be used to provide cancellation information to former jurisdiction
REQUIRED IF NAME CHANGED OR IF PREVIOUSLY REGISTERED TO VOTE IN ANOTHER MT COUNTY OR IN ANOTHER STATE
Previous City, County
and
State
Residence Address of Previous Registration
Previous Registration Name
5(&(,9(<285%$//27,17+(0$,/
Yes, I request an absentee ballot to be mailed to me for all elections in which I am
eligible
to vote as long as I reside at the add
listed on this application. I understand that in order to continue to receive an absentee ballot, I must complete, sign, and return a
address confirmation notice mailed to me by the county election office in January of each even-numbered year.
If your mailing address differs during certain times of the year please add the seasonal mailing address information in this
space, or contact your county election office. Seasonal mailing address for the period of
____/____/______ through ____/____/______ Seasonal Mailing Address:______________________________________________________________________
I
affirm under
penalty of
perjury that the
information on this
application
is true,
that
I am a citizen of the United States, that I will be at
least 18 years old on or before the next election, that I will have been a resident of Montana for at least 30 days prior to the next
election, and
that
I am
not
serving a felony
conviction
in a
penal
institution
nor have been found
to be of unsound mind by a court. I
understand that if I have given
false information on this application,
I may be
subject
to a
fine
or imprisonment, or
both, under federal
Signature*
Date*
THE AFFIRMATION ON THIS APPLICATION FOR VOTER REGISTRATION MUST BE SIGNED BY THE APPLICANT – FAILURE TO DO SO WILL PREVENT APPLICATION FROM BEING PROCESSED.
MONTANA
VOTER
REGISTRATION APPLICATION
Fields marked
with
an asterisk (*)
are
required. If
you
do not provide all of the required information,
your
application
to register
to vote will not be complete.
UNDER FEDERAL AND/OR STATE LAW ALL ELECTORS MUST PRESENT ID WHEN VOTING.
Please type or print clearly using black or blue ink. COMPLETE FORM AND SUBMIT TO COUNTY ELECTION OFFICE.
9/2013
click to sign
signature
click to edit
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