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
2
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.
3
Last Name*
First Name*
Middle Name (Optional)
Suffix
(Jr., Sr., Etc.
)
4 Date of Birth*
_________/________ /________
month day year
Contact Phone Number (Optional)
Email Address (Optional)
5 Select one of the following and provide the required information*
6 Montana Residence Address*
City* County* Zip Code*
7
Mailing Address (required if differs from residence address)
City
State
Zip Code
8
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
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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
address listed on this application. I understand that if I file a change of address with the U.S. postal service, I must complete, sign, and
return a confirmation notice mailed to me by the county election office.
If y
our 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:______________________________________________________________________
APPLICANT
AFFIRMATION
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
and/or
state law.
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.
For
county use only
Date
Senate
House
Precinct / Split
Ward
School
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.
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; tribal ID;
or government document).
ID numbers provided above are kept confidential and are not available for public inspection.
03/2020
Beaverhead 2 S Pacific St No 3 Dillon MT 59725 McCone Box 199
Big Horn PO Box 908 Hardin MT 59034 Meagher Box 309
Blaine PO Box 278 Chinook MT 59523 Mineral Box 550
Broadwater
515 Broadway St
Townsend MT 59644 Missoula
140 N Russell St
Circle MT 59215
White Sulphur Springs MT 59645
Superior MT 59872
Missoula MT 59801
Carbon PO Box 887 Red Lodge MT 59068 Musselshell 506 Main Roundup MT 59072
Carter Box 315 Ekalaka MT 59324 Park 414 E Callender St Livingston MT 59047
Cascade Box 2305 Great Falls MT 59403 Petroleum Box 226 Winnett MT 59087
Chouteau Box 459 Fort Benton MT 59442 Phillips Box 360 Malta MT 59538
Custer 1010 Main Miles City MT 59301 Pondera 20 4th Ave SW Conrad MT 59425
Daniels Box 247 Scobey MT 59263 Powder River Box 200 Broadus MT 59317
Dawson 207 West Bell Glendive MT 59330 Powell 409 Missouri Deer Lodge MT 59722
Deer Lodge 800 Main Anaconda MT 59711 Prairie Box 125 Terry MT 59349
Fallon Box 846 Baker MT 59313 Ravalli 215 S 4th St Ste C Hamilton MT 59840
Fergus 712 W Main Lewistown MT 59457 Richland 201 W Main Sidney MT 59270
Flathead
40 11th St W Ste 230
Kalispell MT 59901 Roosevelt 400 2nd Ave S Wolf Point MT 59201
Gallatin 311 W Main Rm 210 Bozeman MT 59715 Rosebud Box 47 Forsyth MT 59327
Garfield Box 7 Jordan MT 59337 Sanders Box 519 Thompson Falls MT 59873
Glacier 512 E Main Cut Bank MT 59427 Sheridan 100 W Laurel Ave Plentywood MT 59254
Golden Valley PO Box 10 Ryegate MT 59074 Silver Bow 155 W Granite Rm 208 Butte MT 59701
Granite Box 925 Philipsburg MT 59858 Stillwater Box 149 Columbus MT 59019
Hill 315 4th St Havre MT 59501 Sweet Grass Box 888 Big Timber MT 59011
Jefferson Box H Boulder MT 59632 Teton Box 610 Choteau MT 59422
Judith Basin Box 427 Stanford MT 59479 Toole 226 1st St S Shelby MT 59474
Lake 106 4th Ave E Polson MT 59860 Treasure Box 392 Hysham MT 59038
Lewis & Clark 316 N Park Ave Rm 168 Helena MT 59623 Valley 501 Court Sq Box 2 Glasgow MT 59230
Liberty Box 459 Chester MT 59522 Wheatland Box 1903 Harlowton MT 59036
Lincoln 512 California Libby MT 59923 Wibaux PO Box 199 Wibaux MT 59353
Madison Box 366 Virginia City MT 59755 Yellowstone Box 35002 Billings MT 59107
Please place in envelope, affix postage, and send to your county Election Administrator office
County Election Administrator Address
County Election Administrator
Address