Tax Assessor-Collector & Voter Registrar
VTR-006 www.hctax.net Rev 7/18 v6
Voter Registration Application Request Form
Requestor Information
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.
Secretary of State (Pre-addressed to Harris County)
Secretary of State (Pre-addressed to Harris County)
Secretary of State (Pre-addressed to Harris County)
Secretary of State (Pre-addressed to Harris County)
HCTO English with detachable receipt -
HCTAC English/Spanish long form with detachable receipt
HCTAC English/Vietnamese long form with detachable receipt
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 sŽƚĞƌRegistrars.
Limited supply of voter registration applicationƐ requires us to limit orders. Thank you for
understanding and ĨŽƌLJŽƵƌcooperation.
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
Internal Use Only
Applications ordered via Inventory Program.
Request entered into Daily Application Request Log.
E-mail sent to Branch Office or DC (customer order being delivered; branch office to notify customer).
Order in excess of limited amount approved by (Voter Dept. Manager):
Order in excess of limited amount approved by (Voter Dept. Manager):
Requestor picked up applications.
dŝŵe:
M
WM
Volunteer Deputy Voter Registrars Only