UT LI
CENSE # UT ID
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VOTER REGISTRATION
YES
NO
Do you authorize the use of information in this form for voter registration purposes?
"PRIVACY INFORMATION"
Voter registration records contain some information that is available to the public, such as your name and address, some information that is available only to government entities,
and some information that is available only to certain third parties in accordance with the requirements of law. Your driver license number, identification card number, social
security number, email address, and full date of birth are available only to government entities. Your year of birth is available to political parties, candidates for public office,
certain third parties, and their contractors, employees, and volunteers, in accordance with the requirements of law. You may request that all information on your voter
registration records be withheld from all persons other than government entities, political parties, candidates for public office, and their contractors, employees, and volunteers,
by indicating here:
Yes, I request that all information on my voter registration records be withheld from all persons other than government entities, political parties, candidates for public
office, and their contractors, employees, and volunteers.
REQUEST FOR ADDITIONAL PRIVACY INFORMATION
In addition to the protections provided above, you may request that all information on your voter registration records be withheld from all political parties, candidates for public
office, and their contractors, employees, and volunteers, by submitting a withholding request form, and any required verification, as described in the following paragraphs. A
person may request that all information on the person's voter registration records be withheld from all political parties, candidates for public office, and their contractors,
employees, and volunteers, by submitting a withholding request form with this registration record, or to the lieutenant governor or a county clerk, if the person is or is likely to be,
or resides with a person who is or is likely to be, a victim of domestic violence or dating violence.
A person may request that all information on the person's voter registration records be withheld from all political parties, candidates for public office, and their contractors,
employees, and volunteers, by submitting a withholding request form and any required verification with this registration form, or to the lieutenant governor or a county clerk, if the
person is, or resides with a person who is, a law enforcement officer, a member of the armed forces, a public figure, or protected by a protective order or a protection order.
Yes, I would like a withholding form.
Political Party:
Constitution
Democtratic
Republican
United Utah Unaffiliated
Other _____________
To register or preregister to vote in Utah, you must be a citizen of the United States, have resided in Utah for 30 days immediately before the next election, and not be a
convicted felon currently incarcerated for a felony. You must be 16 or 17 years old to preregister to vote or at least 18 years old on or before the next general election to register
to vote. If you decline to register to vote, the fact that you have declined will remain confidential and will be used only for voter registration purposes. If you register to vote, the
office with whom you register will remain confidential. The portion of your voter registration form that lists your license or identification card number, social security number,
email address, and the day of your month of birth is a private record. The portion of your voter registration form that lists your month and year of birth is a private record, the use
of which is restricted to government officials, government employees, political parties, or certain other persons. In order to be allowed to vote in a voting precinct for the first time
or to vote during the early voting period before the date of the election, you must present valid voter identification to the poll worker before voting as follows: (1) a valid form of
photo identification that shows your name, photograph, and current address; or (2) two different forms of identification that show your name and current address.
CITIZENSHIP AFFIDAVIT/VOTER DECLARATION
I hereby swear and affirm, under penalties for voting fraud set forth in Utah Code Sec. 20A-2-401 that I am a citizen of the United States and that to the best of my knowledge
and belief the information I have given is true and correct.
I do swear (or affirm), subject to penalty of law for false statements, that the information contained in this form is true, and that I am a citizen of the United States and a resident
of the State of Utah, residing at the above address. Unless I have indicated that I am preregistering to vote in a later election, I will be at least 18 years of age and will have
resided in Utah for 30 days immediately before the next election. I am not a convicted felon currently incarcerated for commission of a felony.
Libertarian
_______________X_________________________________
Sign ABOVE to register to vote Date
By submitting this application, I am consenting to registration with the Selective Service System, if required by federal law. Refusal to consent to the release of information to the
Selective Service System shall result in the denial of the license and/or identification card.
Implied Consent - By operating a motor vehicle in this state you have given consent to a chemical test of your breath, blood, urine, or oral fluids for the purpose of determining if
you are operating or in actual physical control of a motor vehicle while having a blood or breath alcohol content or are under the influence of drug or a combination of both that is
prohibited by Utah law.
FAILURE TO TRUTHFULLY COMPLETE QUESTIONS MAY RESULT IN WITHDRAWAL OF DRIVING PRIVILEGE OR IDENTIFICATION CARD.
The Driver License Division may disclose the information provided on this form in accordance with Utah Code Annotated 53-3-109.
The Driver License Division may disclose the information provided on this form to an entity described in Utah Code Annotated Subsection 53-3-109(1)(b)(v).
Please visit our website dld.utah.gov for additional information.