STATE OF IOWA OFFICIAL VOTER REGISTRATION FORM
In Iowa, you are not qualified to vote following a felony conviction until your right to vote is restored by
the Governor. To learn more about voting after a felony conviction visit RestoreYourVote.iowa.gov.
1. Are you a citizen of the United States? Yes No
2. Will you be 18 years of age on or before Election Day? Yes No
If you answered “No” to either of these questions, do not complete this form.
IA driver’s license #:
IA non-operator ID #:
Last 4 digits of Social Security number: XXX – XX –
I do not have an IA driver’s license, non-operator ID, or Social Security number.
Date of Birth (month, day, year) / /
Sex Male Female
Phone and/or Email (optional)
Last
First
Middle Suffix
Street Address
(include apt., lot, etc.)
City Zip County
If homeless or you do not have an established residence, describe where you reside:
Address/P.O. Box
City State Zip
Your name was
Your address was
Your city and state were Your zip was
Political Parties: Democratic Republican No Party
Non-Party Political Organizations: Green Libertarian
I swear or affirm under penalty of perjury that:
▪ I am the person named above.
▪ I am a citizen of the United States.
▪ I have never been convicted of a felony OR my right to vote has been restored
by the Governor, including through Executive Order, after a felony conviction.
▪ I am at least 17 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.
Signature Date
Revised 10/02/2020
Political
Affiliation
(check only one)
ID Number
Provide your Iowa
driver’s license, non-
operator ID number,
or the last 4 digits of
your Social Security
number if you have
one.
Where You
Receive Mail
(if different)
Previous
Voter
Registration
Information
Additional
Information
Date of birth and
sex are required.
WARNING
If you sign this
form and you
know the
information is
not true, you
may be
convicted of
perjury and
fined up to
$7,500 and/or
jailed for up to
5 years.
