Fillable Form 100 Colorado Voter Registration Form printable pdf download

Colorado Voter Registration Form

Fill out all fields marked with an asterisk (*)

Eligibility

* Are you a citizen of the United States?

Yes

If you answered "No", do not complete this form.

Name

* Last Name

* First Name

Middle Name

Suffix

I have a valid CO Driver's License or ID card

and that number is:

Identification

Provide your birth date

I do not have a CO Driver's License or ID card, but

and check one of the

the last 4 digits of my Social Security Number are:

* Birth date (MM / DD / YYYY)

boxes.

I do not have a Colorado Driver's License, ID card, or a Social Security Number.

The address

* Address (no P.O. Boxes)

Unit Number

* City or Town

where you live

State

* Zip Code

Colorado County

*When did you move to this address?

The address

Same as above

Address

where you

receive mail

City or Town

State

Zip Code

The address to

Same as above

mail your ballot

Address

The County will mail your

ballot here until you say

otherwise.

City or Town

State

Zip Code

American Constitution

Political party

Green

Republican

Unaffiliated

Select one.

Democratic

Libertarian

Unity

Updating a

Previous home address

Previous legal name

current record?

If so, you must provide the

Previous mailing address

Previous party affiliation

applicable changes here.

I am no longer overseas

I am no longer absent from Colorado due to military service

Warning:

A violation of the self-affirmation you are about to make is a criminal act under the laws of this state and will subject you to the

penalties provided by law. It is a Class 1 misdemeanor to swear or affirm falsely as to your qualifications to vote.

I am aware that if I register to vote in Colorado I am also considered a resident of Colorado for motor vehicle registration and operation purposes and

for income tax purposes.

Self-Affirmation:

I affirm that I am a citizen of the United States; I have been a resident of the state of Colorado for at least twenty-two days

immediately prior to an election in which I intend to vote; and I am at least sixteen years old and understand that I must be eighteen years old to be

eligible to vote. I further affirm that my present address as stated herein is my sole legal place of residence, that I claim no other place as my legal

residence, and that I understand that I am committing a felony if I knowingly give false information regarding my place of present residence. I certify

Declaration

under penalty of perjury that I meet the registration qualifications; that the information I have provided on this application is true to the best of my

knowledge and belief; and that I have not, nor will I, cast more than one ballot in any election.

* Signature or mark

Witness Signature

* Date

Date

If you are unable to sign, you must make a mark and have the mark witnessed by another person.

I would like to be an election judge

Optional

Phone number with area code

Gender

information

I want to receive election information by email: