EL-131 (REV 2016-09)
Wisconsin Voter Registration Application
Submitted by Mail
(Official Use Only)
Confidential Elector ID#
(HINDI - sequential #) (Office Use Only)
WisVote ID #
(Office Use Only)
Instructions for completion are on the back of this form. Return this form to your municipal clerk, unless directed otherwise.
Proof of Residence (see reverse) must accompany this application unless you are a military or permanent overseas voter.
If this is a change of address, upon completion of this application your voting rights will be cancelled at your previous residence.
Please print your information clearly and legibly. Fill in circles as applicable.
1
New WI Voter
Name Change
Address Change
Municipality
County
2
WI Driver License or WI DOT-issued ID #
(Req. if not expired or cancelled)
Expiration Date
/ /
I have neither
a WI Driver
License/ ID nor a
Social Security
Number.
Social Security Number - Last Four Digits
(Req. if driver license or state ID is not issued, has expired, or has been
3
Current
Last Name
First Name
Middle
Name
Suffix
(e.g. Jr, II, etc.)
Phone #
Date of Birth
(M/D/YYYY)
Email Address
If you are a military or permanent overseas elector, fill in the appropriate circle
(see
instructions
for
definitions)
Military
Permanent
Overseas
4
Residence Address: Street Number & Name
Apt. Number
City
State & ZIP
5
Mailing Address: Street Number & Name
Apt. Number
City
State & ZIP
6
Previous
Last Name
First Name
Middle
Name
Suffix
(e.g. Jr, II, etc.)
7
Previous Address: Street Number & Name
Apt. Number
City
State & ZIP
8
Accommodation needed at poll location (e.g. wheelchair
access):
If you do not have a street number or address, use the map to show where you live.
Mark crossroads
I am interested in being a poll worker.
‘X’ where you live
Use dots for
landmarks
9
Please answer the following questions by filling in “Yes” or No”
If you filled in “No” in response to EITHER 1. Are you a citizen of the United States of America?
2. Will you be 18 years of age or older on or before the first
election at which you will offer to vote?
of these questions, do not complete this form.
10
I hereby certify, to the best of my knowledge, that I am a qualified elector, a U.S. citizen, at least 18 years old or will be at least 18 years old at the time
of the first election at which I will offer to vote, having resided at the above residential address for at least 10 consecutive days immediately preceding
this election, with no present intent to move. I am not currently serving a sentence including incarceration, parole, probation, or extended supervision
for a felony conviction, and not otherwise disqualified from voting. I certify that all statements on this form are true and correct. If I have provided false
information I may be subject to fine or imprisonment under State and Federal laws. If completed on Election Day: I further certify that I have not
voted in this election. Please sign below to acknowledge that you have read and understand the above.
11
Elector Signature
X
Today’s Date
Proof of Residence Type (Official use only)
Proof of Residence Issuing Entity (Official use only)
Proof of Residence # (Official Use Only)
Election Day Voter # (Official Use Only)
Falsification of information on this form is punishable under Wisconsin law as a Class I felony.
12
Assistant Signature:
Assistant Address:
Official’s Signature:
Date Complete & POR Received
/ /
SRDs printed name and SRD#:
Ward
Sch. District
Alder
Cty. Supr.
Ct. of App.
Assembly
St. Senate
Congress
Instructions
Town
Village
City
O
O
O
Example
Marmot Road
High School
Library
X
N
Yes
No
Yes
No
/ /
cancelled
)
X X X - X X -
EL-131 (REV 2016-09)
Wisconsin Voter Registration Application Instructions
Each section on the front side of this document corresponds to the sections below (1-12)
These do
cuments
constitute proof of
residence if they contain
the voter’s current and
complete first and last
name and residential
address, and are valid on
the day used to register
to vote.
Electronic versions are
also a
cceptable
A WI Driver License/ID Card, if not expired or cancelled; may be used even if driving privileges have been revoked
Any other official identification card or license issued by a Wisconsin governmental body or unit
An employee ID card with a photograph, but not a business card
A real property tax bill or receipt for the current year or the year preceding the date of the election
A residential lease (Does not count as proof of residence if elector submits form by mail)
A picture ID from a university, college or technical college coupled with a fee receipt or an on-campus housing listing
provided by the university, college or technical college
A utility bill for the period commencing not earlier than 90 days before the day registration is made
(Homeless voters only) A letter from an organization that provides services to the homeless that identifies the voter
and describes the location designated as the person’s residence for voting purposes
A contract/intake document prepared by a residential care facility indicating that the occupant resides in the facility
A bank statement
A paycheck
A check or other document issued by a unit of government
1
Fill in the circle (New WI Voter, Name Change, Address Change) describing why you are completing the form.
A “New WI Voter” is anyone who is not currently registered to vote in Wisconsin. You can check your voter
registration status at MyVote Wisconsin website (https://myvote.wi.gov)
Indicate your county and municipality of residence (e.g. Town of Eaton, Manitowoc County).
2
If you have been issued a WI driver license or WI DOT-issued ID that is unexpired, you must provide the number
,
even if your driving privileg
es have been revoked. If you are unsure of the number, please cal
l DMV at
(608
) 266-23
53.
If you have been issued a WI driver license or WI DOT-issued ID that is currently expired or has been canc
elled,
plea
se provide the number. You must also provide the last 4 digits of your Social Security num
ber.
If you have not been issued a WI driver license or WI DOT-issued ID, you must provide the la
st 4 digits of your
Social Se
curity number.
If you have not been issued a WI driver license, a WI DOT-issued ID, or a Social Security number, indi
cate that
fact by filling in the approp
riate circle.
If you are registering to vote on Election Day and have been issued a WI driver license or ID, but are unabl
e or
unwilling to provide the number, your
vote will not be counted unless you pr
ovide the number to the election
insp
ectors by 8:00 p.m. on Election Day or to your municipal clerk by 4:00 p.m. the Friday following Election
Day.
3
Provide your current and complete name including your last name, first name, middle nam
e, and suffix (Jr., Sr.,
etc.), if any.
Please verify you have provided your name as it appears on the document, the number of whic
h you
provided in Box 2, if the name on that document is still your current and complete name.
Provide your month, day, and year of birt
h.
Providing your phone number and/or email address is optional and is subject to open records requests.
A “military elector” is a person, or the spouse or dependent of a person who is a member of a uniform
ed service
or merch
ant marine, a civilian officially attached to a uniformed service and serving outside th
e United States, or
a Peace
Corp volunteer. Military electors are not required to register as a prerequisite to voting at any elect
ion.
A “permanent overseas elector” is a US citizen, at least 18 years old, who does not qualify as a resid
ent of this
state, but wh
o was last domiciled in this state, or whose parent was last domiciled in this state immediatel
y prior
to the parent’
s departure from the United States, and who is not registered to vote in any other state.
4
Provide your home address (legal voting residence) in Wisconsi
n.
Provide your full street name, including the type (St, Ave, etc.) and any pre-and/or post-directional (N, S, etc.).
Provide the city name and zip that appears on mail delivered to your home add
ress.
You may not enter a PO Box as a residential address. A rural route box without a number should not be used.
5
If your mailing address is different from your home address, provide it here. A PO Box is acceptable as a
mailing
address. Oversea
s electors should provide their complete overseas address here.
6
Provide your previous first, last and middle names, along with a su
ffix, if any.
7
Provide the most recent address where you were previously regist
ered to vote, if any.
8
If you need assistance when voting, you may describe the assistance required (e.g. curbside voting, braill
e
material
s).
If you are interested in being a poll worker for your municipality, you may fill in the circle to indicate your interest.
If you do not have a street address, use the map to sh
ow where you live.
9
If you answer “No” to either question in this section, you are not eligible to vote in Wisconsi
n.
Please note, for question 2, you must either be at least 18 y
ears old, or will be at least 18 years old at the time
of the next election to be e
ligible to vote. If you are completing on Election Day you must be 18 years ol
d today.
12
Assistant: If you are unable to sign this form due to a physical disability, you may have an assistant do so on
your behalf. That assistant must provide his or her signature and address in the space provided. By signing,
the assistant certifies that he or she signed the form at your request.
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