Tax Assessor-Collector & Voter Registrar
VTR-006 www.hctax.net Rev 7/18 v6
Voter Registration Application Request Form
Date:
Request Made:
In Person
By Phone
E - Mail
Branch Location:
Representative:
Requestor Information
Name:
Phone:
Organization:
VDVR#:
Address:
City:
State:
Zip:
Means of Distribution: (community event, etc.)
Applications Requested
For large or special requests, please contact the Voter Registration Department at 713-274-8200 or voters@hctx.net.
Application Type
Form #
Description
Quantity
English
HCTO 453
Secretary of State (Pre-addressed to Harris County)
Spanish
HCTO 458
Secretary of State (Pre-addressed to Harris County)
Vietnamese
HCTO 455
Secretary of State (Pre-addressed to Harris County)
Chinese
HCTO 454
Secretary of State (Pre-addressed to Harris County)
English only
HCTO 459
HCTO English with detachable receipt -
English/Spanish
VTR172014S13
HCTAC English/Spanish long form with detachable receipt
English/Vietnamese
VTR172014V13
HCTAC English/Vietnamese long form with detachable receipt
English/Chinese
VTR172014C13
HCTAC English/Chinese long form with detachable receipt
Note: There is a limit of 50 applications per request for the public and 200 applications per request for Volunteer Deputy sŽƚĞƌRegistrars.
Limited supply of voter registration applicationƐ requires us to limit orders. Thank you for
understanding and ĨŽƌLJŽƵƌcooperation.
Pick-up Information
(if applicable)
Bay Area: 16603 Buccaneer Ln.
Humble: 7900 Will Clayton Pkwy.
Palm Center: 5300 Griggs Rd.
Baytown: 701 W. Baker Rd.
Jim Fonteno: 14350 Wallisville Rd.
Raul C Martinez: 1001 S Sgt. Macario Garcia
Bellaire: 6000 Chimney Rock Rd.
John Phelps: 101 N. Richey at Hwy. 225
Scarsdale: 10851 Scarsdale Blvd.
Clay Road: 16715 Clay Rd.
Kyle Chapman: 7330 Spencer Hwy.
Spring Branch: 1721 Pech Rd.
Mickey Leland: 7300 N. Shepherd Tomball: 101 S. Walnut
Downtown: 1001 Preston
Distribution Center: 11525 Todd
Date Requested:
Pickup Date:
Day of Week:
Internal Use Only
Applications ordered via Inventory Program.
Inventory Order #:
Date:
Request entered into Daily Application Request Log.
Date:
E-mail sent to Branch Office or DC (customer order being delivered; branch office to notify customer).
Date:
Order in excess of limited amount approved by (Voter Dept. Manager):
Date:
Order in excess of limited amount approved by (Voter Dept. Manager):
Date:
Date: Date:
Requestor picked up applications.
dŝŵe:
M
WM
Volunteer Deputy Voter Registrars Only
DOWNTOWN ONLY