Florida Voter Registration Application
Part 1 – Instructions (DS-DE #39, R1S-2.040, F.A.C. (eff. 01/2012)
Información en español: Sirvase llamar a la oficina del supervisor de
elecciones de su condado si le interesa obtener este formulario en español.
To Register in Florida, you must be:
A U.S. citizen,
A Florida resident, and
At least 18 years old (you may also pre-
register if you are 16 or 17 years old but you
cannot vote until you are 18).
If you have ever been convicted of a felony or if
a court has ever found you to be mentally
incapacitated as to your right to vote, your right
to vote must be restored before you can
register.
If you do not meet any one of these
requirements, you are not eligible to
register.
Where to Register: You can register to vote
in-person or by mailing or hand-delivering your
application to any supervisor of elections’
office, any office that issues driver’s licenses
any voter registration agency (for example, any
public assistance office,
center for independent
living,
office serving persons with disabilities,
public library, or armed forces recruitment
office) or the Division of Elections. If mailing
application, be sure to add sufficient postage.
Deadline to Register: The deadline to register
to vote is 29 days before an upcoming election.
You can update your registration record at any
time, but to change your political party for a
primary election, you must make the change by
the registration deadline. For a new application,
you will be contacted if your application is
incomplete, denied or a duplicate of an existing
registration. If you receive a voter information
card, that means you are registered to vote.
Identification (ID) Requirements: If you are a new
applicant, state and federal law require you to
provide a current and valid Florida driver’s license
number (FL DL#) or Florida identification card
number (FL ID#). If you have not been issued a FL
DL# or FL ID#, you must then provide the last four
digits of your Social Security Number (SSN). If you
have not been issued any of these ID numbers,
check “None” on the application. If you do not
provide any number or do not check “None,” your
registration may be denied. See s.303, HAVA and
section 97.053(6), Fla. Stat.
Special ID requirements: If you are registering by
mail, have never voted in Florida, and have never
been issued one of the ID numbers above, you must
include with your application, or at a later time before
you vote, one of the following:
A copy of an ID that shows your name and photo
(acceptable IDs)--U.S. Passport, debit or credit
card, military ID, Student ID, retirement center ID,
neighborhood association ID, or public assistance
ID; or
A copy of an ID that shows your name and current
residence address (acceptable documents)--utility
bill, bank statement, government check, paycheck,
or other government document.
You do not have to provide the special ID to register
if you are 65 or older, have a temporary or
permanent physical disability, are a member of the
active uniformed services or merchant marine who is
absent from the county for active duty, or a family
member thereof, or are currently living outside the
U.S. but otherwise eligible to vote in Florida. If you
vote at the polls, you will still need to show a
photo/signature ID as is required of all voters.
Political Party Affiliation: Florida is a closed primary election state.
That means registered voters affiliated with a political party can only
vote for that party’s candidates in a partisan race on a primary election
ballot. However, regardless of the political party with which you
registered, you can still vote in the primary election on any issue, any
nonpartisan race or any race where the candidate will face no
opposition in the general election.
Indicate the political party with which you wish to be registered. If you
leave the political party affiliation field blank, you will be registered
without any party affiliation. For a list of political parties registered in
Florida, go to the Division of Elections’ website under the heading For
the Voters at:
http://election.dos.state.fl.us/
Race/Ethnicity: You are not required to list your race or ethnicity.
However, if you choose to do so, please choose only one from the list.
Public Record Notice: This application becomes a public record
when filed. However, the following information is not available to the
public and is used only for voter registration purposes: your FL DL#,
FL ID# and SSN, where you registered to vote, and whether you
declined to register or update your voter registration record when
asked by a voter registration agency. Your signature can be viewed
but not copied. (Section 97.0585, Fla. Stat.)
Criminal Offense: It is a 3rd degree felony to submit false
information. Penalties include fines up to $5,000 and/or up to 5 years
of prison.
Questions: For more information, contact your local supervisor of
elections
http://election.dos.state.fl.us/SOE/supervisor_elections.shtml
or refer to the Division of Elections’ website at:
http://election.dos.state.fl.us.
All shaded lettered boxes are
required for a new registration.
Florida Voter Registration Application
Part 2 – Form (DS-DE #39, R1S-2.040, F.A.C. (eff. 01/2012)
The downloadable/printable online form is available at:
http://election.dos.state.fl.us/pdf/webappform.pdf
This is: New Registration Record Update/Change (e.g., Address, Party Affiliation, Name, Signature) Request to Replace Voter Information Card
A
Are you a citizen of the United States of America? YES NO
B
I affirm that I am not a convicted felon, or if I am, my right to vote has been restored.
C
I affirm that I have not been adjudicated mentally incapacitated with respect to
voting or, if I have, my right to vote has been restored.
D
Date of Birth (Enter in format MM-DD-YYYY)
-
-
E
Florida Driver’s License (FL DL) or Florida identification (FL ID) Card Number
If no FL DL
or FL ID,
then
provide
Last 4 digits of Social
Security Number
I have
NONE of
these
numbers.
-
-
-
-
F
Last Name
First Name
Middle Name or Initial
Name Suffix
(Jr., Sr., I, II, etc.):
G
Address Where You Live (legal residence-no P.O. Box)
Apt/Lot/Unit
City
County
Zip Code
Mailing Address (if different from above address)
Apt/Lot/Unit
City
State or Country
Zip Code
Address Where You Were Last Registered to Vote
Apt/Lot/Unit
City
State
Zip Code
Former Name (if name is changed)
Gender
M F
State or Country of Birth
Telephone No. (optional)
( )
Party Affiliation
(Check only one. If left blank, you will
be registered without party affiliation)
Florida Democratic Party
Republican Party of Florida
No party affiliation
Minor political party (print name):
______________________
Race/Ethnicity (Check only one)
American Indian/Alaskan Native
Asian/Pacific Islander
Black, not of Hispanic Origin
Hispanic
White, not of Hispanic Origin
Other:________________
Multi-racial
Active Uniformed Services, Merchant Marine, or
Overseas U.S. Citizen
(Check only one if applicable)
Active duty uniformed services/merchant marine
Family member of active duty uniformed services or
merchant marine member
U.S. Citizen Residing Outside U.S.
I will need
assistance with
voting.
I am
interested in
becoming a poll
worker.
H
Oath: I do solemnly swear (or affirm) that I will
protect and defend the Constitution of the United
States and the Constitution of the State of Florida,
that I am qualified to register as an elector under the
Constitution and laws of the State of Florida, and that
all information provided in this application is true.
SIGN/
MARK
HERE
Date
Address your envelope to
your County Supervisor
of Elections. (updated 7/12/2012)
FLAGLER COUNTY
Supervisor of Elections
PO Box 901
Bunnell FL 32110-0901
386-313-4170
LAKE COUNTY
Supervisor of Elections
PO Box 457
Tavares FL 32778-0457
352-343-9734
PASCO COUNTY
Supervisor of Elections
PO Box 300
Dade City FL 33526-0300
352-521-4302
ALACHUA COUNTY
Supervisor of Elections
111 SE 1st Ave
Gainesville FL 32601
352-374-5252
FRANKLIN COUNTY
Supervisor of Elections
47 Ave. F
Apalachicola FL 32320
850-653-9520
LEE COUNTY
Supervisor of Elections
PO Box 2545
Fort Myers FL 33902
239-533-VOTE (8683)
PINELLAS COUNTY
Supervisor of Elections
13001 Starkey Road
Largo FL 33773-1416
727-464-6788
BAKER COUNTY
Supervisor of Elections
PO Box 505
Macclenny FL 32063
904-259-6339
GADSDEN COUNTY
Supervisor of Elections
PO Box 186
Quincy FL 32353
850-627-9910
LEON COUNTY
Supervisor of Elections
PO Box 7357
Tallahassee FL 32314-7357
850-606-VOTE (8683)
POLK COUNTY
Supervisor of Elections
PO Box 1460
Bartow FL 33831-1460
863-534-5888
BAY COUNTY
Supervisor of Elections
830 W. 11th St.
Panama City FL 32401
850-784-6100
GILCHRIST COUNTY
Supervisor of Elections
112 S. Main St., Room 128
Trenton FL 32693
352-463-3194
LEVY COUNTY
Supervisor of Elections
421 S. Court St.
Bronson FL 32621
352-486-5163
PUTNAM COUNTY
Supervisor of Elections
2509 Crill Ave., Suite 900
Palatka FL 32177
386-329-0224
BRADFORD COUNTY
Supervisor of Elections
PO Box 58
Starke FL 32091
904-966-6266
GLADES COUNTY
Supervisor of Elections
PO Box 668
Moore Haven FL 33471
863-946-6005
LIBERTY COUNTY
Supervisor of Elections
PO Box 597
Bristol FL 32321
850-643-5226
SANTA ROSA COUNTY
Supervisor of Elections
6495 Caroline St., Suite F
Milton FL 32570-4592
850-983-1900
BREVARD COUNTY
Supervisor of Elections
PO Box 410819
Melbourne FL 32941
321-264-6740
GULF COUNTY
Supervisor of Elections
401 Long Ave.
Port St. Joe FL 32456-1707
850-229-6117
MADISON COUNTY
Supervisor of Elections
229 SW Pinckney St., Room 113
Madison FL 32340
850-973-6507
SARASOTA COUNTY
Supervisor of Elections
PO Box 4194
Sarasota FL 34230-4194
941-861-8600
BROWARD COUNTY
Supervisor of Elections
115 S. Andrews Ave., Room 102
Fort Lauderdale FL 33301
954-357-7050
HAMILTON COUNTY
Supervisor of Elections
1153 US Hwy. 41 NW, Suite 1
Jasper FL 32052
386-792-1426
MANATEE COUNTY
Supervisor of Elections
PO Box 1000
Bradenton FL 34206
941-741-3823
SEMINOLE COUNTY
Supervisor of Elections
PO Box 1479
Sanford FL 32772-1479
407-585-VOTE (8683)
CALHOUN COUNTY
Supervisor of Elections
20859 Central Ave. E., Room G10
Blountstown FL 32424
850-674-8568
HARDEE COUNTY
Supervisor of Elections
311 N. 6th Ave.
Wauchula FL 33873
863-773-6061
MARION COUNTY
Supervisor of Elections
PO Box 289
Ocala FL 34478-0289
352-620-3290
ST. JOHNS COUNTY
Supervisor of Elections
4455 Ave. A, Suite 101
St. Augustine FL 32095
904-823-2238
CHARLOTTE COUNTY
Supervisor of Elections
226 Taylor Street, Unit 120
Punta Gorda FL 33950
941-833-5400
HENDRY COUNTY
Supervisor of Elections
PO Box 174
LaBelle FL 33975
863-675-5230
MARTIN COUNTY
Supervisor of Elections
PO Box 1257
Stuart FL 34995
772-288-5637
ST. LUCIE COUNTY
Supervisor of Elections
4132 Okeechobee Road
Fort Pierce FL 34947
772-462-1500
CITRUS COUNTY
Supervisor of Elections
120 N. Apopka Ave.
Inverness FL 34450
352-341-6740
HERNANDO COUNTY
Supervisor of Elections
20 N. Main St., Room 165
Brooksville FL 34601
352-754-4125
MIAMI-DADE COUNTY
Supervisor of Elections
PO Box 521550
Miami FL 33152-1550
305-499-VOTE (8683)
SUMTER COUNTY
Supervisor of Elections
900 N. Main St.
Bushnell FL 33513
352-569-1540
CLAY COUNTY
Supervisor of Elections
PO Box 337
Green Cove Springs FL 32043-0337
904-269-6350
HIGHLANDS COUNTY
Supervisor of Elections
PO Drawer 3448
Sebring FL 33871
863-402-6655
MONROE COUNTY
Supervisor of Elections
530 Whitehead St., Suite 101
Key West FL 33040-6577
305-292-3416
SUWANNEE COUNTY
Supervisor of Elections
210 N. Ohio Ave.
Live Oak FL 32064
386-362-2616
COLLIER COUNTY
Supervisor of Elections
3295 Tamiami Trail E.,
Rev. Dr. MLK Jr. Bldg.
Naples FL 34112
239-252-8450
HILLSBOROUGH COUNTY
Supervisor of Elections
601 E. Kennedy Blvd., 16th Floor
Tampa FL 33602
813-272-5850
NASSAU COUNTY
Supervisor of Elections
96135 Nassau Place, Suite 3
Yulee FL 32097
904-491-7500
TAYLOR COUNTY
Supervisor of Elections
PO Box 1060
Perry FL 32348
850-838-3515
COLUMBIA COUNTY
Supervisor of Elections
971 W. Duval St., Suite 102
Lake City FL 32055-3737
386-758-1026
HOLMES COUNTY
Supervisor of Elections
201 N. Oklahoma St., Suite 102
Bonifay FL 32425
850-547-1107
OKALOOSA COUNTY
Supervisor of Elections
302 Wilson St. N., Suite 102
Crestview FL 32536-3440
850-689-5600
UNION COUNTY
Supervisor of Elections
17
5 W. Main St.
Lake Butler FL 32054
386-496-2236
DESOTO COUNTY
Supervisor of Elections
PO Box 89
Arcadia FL 34265
863-993-4871
INDIAN RIVER COUNTY
Supervisor of Elections
4375 43rd Ave., Unit 101
Vero Beach FL 32967
772-226-3440
OKEECHOBEE COUNTY
Supervisor of Elections
304 NW 2nd St., Room 144
Okeechobee FL 34972
863-763-4014
VOLUSIA COUNTY
Supervisor of Elections
125 W. New York Ave.
DeLand FL 32720-4208
386-736-5930
DIXIE COUNTY
Supervisor of Elections
PO Box 2057
Cross City FL 32628
352-498-1216
JACKSON COUNTY
Supervisor of Elections
PO Box 6046
Marianna FL 32447
850-482-9652
ORANGE COUNTY
Supervisor of Elections
PO Box 562001
Orlando FL 32856
407-836-2070
WAKULLA COUNTY
Supervisor of Elections
PO Box 305
Crawfordville FL 32326-0305
850-926-7575
DUVAL COUNTY
Supervisor of Elections
105 E. Monroe St.
Jacksonville FL 32202
904-630-1414
JEFFERSON COUNTY
Supervisor of Elections
380 W. Dogwood St.
Monticello FL 32344
850-997-3348
OSCEOLA COUNTY
Supervisor of Elections
2509 E. Irlo Bronson Memorial Hwy.
Kissimmee FL 34744
407-742-6000
WALTON COUNTY
Supervisor of Elections
571 E. Nelson Ave. (US Hwy. 90)
DeFuniak Springs FL 32433
850-892-8112
ESCAMBIA COUNTY
Supervisor of Elections
PO Box 12601
Pensacola FL 32591-2601
850-595-3900
LAFAYETTE COUNTY
Supervisor of Elections
PO Box 76
Mayo FL 32066
386-294-1261
PALM BEACH COUNTY
Supervisor of Elections
PO Box 22309
West Palm Beach FL 33416
561-656-6200
WASHINGTON COUNTY
Supervisor of Elections
1331 South Blvd., Suite 900
Chipley FL 32428
850-638-6230
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