Fillable Mail-In Application For Voter Registration printable pdf download

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Mail‐In Application For Voter Registration

You can use this form to:

Are you interested in working on

let us know that your name or address has changed.

Election Day?

To register to vote:

you must be a U.S. citizen, AND

Yes

you must be a resident of Tennessee, AND

you must be at least 18 years old on/or before the next election, AND

you must not have been convicted of a felony, or if you have, your full rights of citizenship must have been restored (or you

must have received a pardon).

Anyone who registers by mail, must vote in person the first time he or she votes after registering.

MAIL OR HAND DELIVER THIS FORM TO: Blount County Election Commission

383 Court Street

Maryville, TN 37804‐5906

Instructions / Checklist:

Please PRINT with a blue or black INK pen (not felt tip).

Provide the information in items 1‐8 below, read the VOTER DECLARATION, and sign by the “X”.

An application for voter registration must be postmarked or hand delivered to the proper county election commission office

at least 30 days before an election.

Voter registration records are public records, open to inspection by any citizen of Tennessee.

YOU ARE NOT REGISTERED TO VOTE UNTIL YOU RECEIVE A VOTER REGISTRATION CARD.

If you are qualified and the information on your form is complete, we will add your name to the

county’s voter rolls. We will then mail you a voter card. This card will tell you where to vote.

For more information, call your county election commission.

FOR COUNTY ELECTION COMMISSION USE ONLY

CHECK ONE: NEW REGISTRATION

Mail __________ Reg # __________ Approved __________ Eff. Date __________

P/A __________ District _________ Precinct ____________ Ward _____________

ADDRESS CHANGE NAME CHANGE

LAST NAME FIRST NAME MIDDLE INITIAL SEX RACE (OPTIONAL)

M F

ADDRESS WHERE YOU LIVE (DO NOT GIVE A P.O. BOX) APT. # CITY COUNTY ZIP CODE

ADDRESS WHERE YOU GET YOUR MAIL (IF DIFFERENT FROM #3)

DATE OF BIRTH PLACE OF BIRTH SOCIAL SECURITY NUMBER

(required under TCA 2‐2‐116 for

DAYTIME PHONE #

purposes of identification and to

5 6

avoid duplicate registration)

NAME AND ADDRESS ON LAST VOTER REGISTRATION

NAME ADDRESS

CITY COUNTY STATE ZIP

VOTER DECLARATION By completing the questions below and

WARNING: Giving false information to register to vote or attempting to

signing my name, I am swearing (or affirming) that the

information I have provided is true, subject to the WARNING as

year nor more than six (6) years’ imprisonment or a fine of $3,000 or both.

stated.

Yes No

1. I am a U.S. citizen.

x_________________________ __________

2. I am a resident of the State of Tennessee.

Signature (or mark) of Applicant Date

3. I will be at least 18 years old on/or before the

next election.

If applicant is unable to sign, provide signature of person who signed for applicant.

4. I have been convicted of a felony.

______________________________________________________________________

Signature of Person Assisting

______________________________________________________________________

Address

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Mail-In Application For Voter Registration

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