State of Alabama Mail-In Voter Registration Form
FOR USE BY U.S. CITIZENS ONLY FILL IN ALL BOXES ON THIS FORM PLEASE USE INK PRINT LEGIBLY
You can use this form to:
Register to vote in Alabama.
Update your voter registration record, if you have
changed your name or address.
Deadline for submitting application:
Voter registration and updating of voter records is closed
during the 14 days prior to each election in Alabama.
To register to vote in the State of Alabama, you must:
Be a citizen of the United States.
Live in Alabama.
Be at least 18 years of age on or before election day.
Not have been convicted of a disqualifying felony, or if you have
been convicted, you must have had your civil rights restored.
Not have been declared "mentally incompetent" by a court.
NVRA-2
ZIP
StateCity
Current
City
Old
Addresses
Home Address (include apartment or other unit number if applicable)
Mailing Address, if dierent from Home Address
Former Address
Print Your Name:
Print Maiden Name / Former Name (if reporting a change of name)
Primary Telephone Email Address
White Black
Asian American Indian
Hispanic Other
I am a U.S. citizen
I live in the State of Alabama
I will be at least 18 years of age on or
before election day
I am not barred from voting by reason of
a disqualifying felony conviction (The list
of disqualifying felonies is available on the
Secretary of State's web site at:
sos.alabama.gov/mtfelonies)
I have not been judged "mentally
incompetent" in a court of law
YOUR SIGNATURE
If you falsely sign this statement, you can be convicted and imprisoned for up to ve years.
Voter Declaration - Read and Sign Under Penalty of Perjury
Date of Birth (mm/dd/yyyy)
Race (check one)
Sex (check one)
Place of Birth
11
Map / Diagram
Did you receive assistance?
12
13
If your home has no street number or name, please draw a map of
where your house is located. Please include roads and landmarks.
If you are unable to sign your name, who helped
you ll out this application? Give name, address,
and phone number (phone number is optional).
City County State Country
County
Address where you live:
(Do not use post oce box)
Address where you
receive your mail:
Address where you were
last registered to vote:
(Do not use post oce box)
REGISTRARS USE ONLY
County Pct
City Pct
DATE APPROVED DENIED
Board member
Board member
Board member
Alabama Driver's
License or Non-
Driver ID Number:
Yes
No
( )
Yes
No
Are you a citizen of the United States of America?
Will you be 18 years of age on or before election day?
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ATTENTION! If you answer "No" to either of these
questions, do not complete this application.
STATE
NUMBER
Last four digits of Social
Security number:
IF YOU HAVE NO ALABAMA DRIVER'S LICENSE
OR ALABAMA NON-DRIVER ID NUMBER
Â
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I solemnly swear or arm to support and
defend the constitution of the United States
and the State of Alabama and further disavow
any belief or aliation with any group which
advocates the overthrow of the governments
of the United States or the State of Alabama
by unlawful means and that the information
contained herein is true, so help me God.
The decision to register to vote is yours. If you decide to register to vote, the oce at which you are submitting this application will
remain condential and will be used only for voter registration purposes. If you decline to register to vote, your decision will remain
condential and will be used only for voter registration purposes.
Questions? Call the Elections Division at 1-800-274-8683 or 334-242-7210
John H. Merrill - Secretary of State
ID requested: You may send with this application a copy of valid photo identication. You will be required to present valid photo identication when you vote at your polling place
or by absentee ballot, unless exempted by law. For more information, go to www.AlabamaVoterID.com or call the Elections Division: 800-274-8683.
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First Middle Last Sufx
I do not have an Alabama driver's license or Alabama
non-driver ID or a Social Security number.
(mm/dd/yyyy)
DATE
(mm/dd/yyyy)
First Middle Last Sufx
ZIP
StateCity
ZIP
State
2019.03.20
Female Male
