Postcard Voter Registration Form - State Of Alabama
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2State of Alabama Postcard Voter Registration Form
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FOR USE BY U.S. CITIZENS ONLY
FILL IN ALL BOXES ON THIS FORM!
USE INK!
DO NOT USE A PENCIL!
You can use this form to:
To register to vote in the State of Alabama, you must:
!
!
Register to vote in Alabama.
Be a citizen of the United States.
!
!
Update your voter registration record, if you have changed
Reside in Alabama.
!
your name or address.
Be at least 18 years old.
!
Have not been convicted of a felony, or if you have been
Deadline for submitting application:
convicted, you must have had your civil rights restored.
Registration and updating of voter records cuts off ten days
!
Have not been declared "mentally incompetent" by a court.
prior to each election in Alabama.
Yes Attention! If you answered "no," you are not
Are you a citizen of the United States?
Statement of U.S. Citizenship
No
eligible to register to vote in the State of Alabama.
Your name:
Last
First
Middle
Social Security Number:
Maiden Name / Former name (if reporting a change of name)
Social Security Number is requested, but not required, by authority of
§17-4-122, Code of Alabama, 1975, for record-keeping purposes.
Home Telephone
Work Telephone
Inside City Limits?
If yes, please name the city:
County where you live
Yes
No
House Number and Street
City
State
ZIP
Address where you live:
(do not use post office box)
House Number and Street (or PO Box)
City
State
ZIP
Address where you
receive your mail:
House Number and Street
City
County
State
ZIP
Address where you were
last registered to vote:
(do not use post office box)
11
Place of Birth
Date of Birth
(month, day, year)
City
County
State
Country
12
13
Race
(check one)
Map / Diagram
Did you receive assistance?
If your house has no street number or name, please draw a map of
If you are unable to sign your name, who helped
White
Black
where your house is located. Please include roads and landmarks.
you fill out this application? Give name, address,
Asian
American Indian
and phone number (phone number is optional).
Hispanic
Other
Sex
(check one)
Female
Male
REGISTRARS USE ONLY
County Pct
VOTER DECLARATION - READ AND SIGN
City Pct
! ! ! ! ! I am a U.S. citizen
I SOLEMNLY SWEAR OR AFFIRM TO SUPPORT AND
! ! ! ! ! I live in the State of Alabama
DEFEND THE CONSTITUTION OF THE UNITED STATES
DATE APPROVED
! ! ! ! ! I am at least 18 years old
AND THE STATE OF ALABAMA AND FURTHER DISAVOW
! ! ! ! ! I am not barred from voting by
ANY BELIEF OR AFFILIATION WITH ANY GROUP WHICH
reason of a felony conviction
ADVOCATES THE OVERTHROW OF THE GOVERNMENTS
Board member
! ! ! ! ! I have not been judged "mentally
OF THE UNITED STATES OR THE STATE OF ALABAMA BY
incompetent" in a court of law
UNLAWFUL MEANS AND THAT THE INFORMATION
CONTAINED HEREIN IS TRUE, SO HELP ME GOD.
Board member
Your Signature: ________________________________________
Date: _______________
WARNING!
If you sign this statement even though you know it is untrue, you can be
Board member
convicted and imprisoned for up to five years.
Questions? Do you need assistance?
Please call your county Board of Registrars at the number listed on the back of this form.
You may also call the Alabama Office of Voter Registration at 334-242-4337.
Call the Office of Secretary of State Jim Bennett
at 1-800-274-VOTE (1-800-274-8683) or 334-242-7210
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