Fillable Wisconsin Voter Registration Application (Page 2 of 2) in pdf

Wisconsin Voter Registration Application Instructions

Each section on the front side of this document corresponds to the sections below (1-12)

These documents

A current and valid WI Driver License / ID Card

constitute proof of

Any other official identification card or license issued by a Wisconsin governmental body or unit

residence if they:

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

Contain the voter’s

A residential lease (Does not count as proof of residence if elector submits form by mail)

current and complete first

A picture ID or fee card from a university, college or technical college

and last name and

A utility bill for the period commencing not earlier than 90 days before the day registration is made

residential address, and

are valid on the day used

A bank statement

to register to vote.

A paycheck

Fill in the circle (New Voter, Name Change, Address Change) describing why you are completing this form.

If your municipal information has not been preprinted, indicate your municipality and county of residence. Use

formal names (For example: City of Plymouth, Village of Chenequa, or Town of Aztalan). If in doubt, contact

your municipal clerk.

Provide your WI Department of Transportation (DOT) Driver License Number.

If you do not have a current and valid WI Driver License, but do have a WI DOT-issued Identification (ID) Card,

provide that number.

If you do not have a WI DOT Driver License or ID Card, provide the last 4 digits of your Social Security Number.

If you have none of these, indicate that fact by filling in the appropriate circle.

If you have a WI Driver License, but do not provide the number, your registration application cannot be

processed.

If you are registering to vote on Election Day and you have a WI Driver License, but do not provide the number,

your vote will not be counted unless you provide the number by the close of the polls or by 4 pm the following

day to your municipal clerk.

Provide your current and complete name as it appears on the document, the number of which you provided in

Box 2, including your last name, first name, middle name or initial and suffix (Jr, Sr, etc), if any.

Provide your month, day and year of birth. Remember to use your birth year, not the current year.

Providing your phone number and/or email address is optional, but will help your municipal clerk to contact you

in case of problems with your registration.

Provide your home address (legal voting residence), which must be located in Wisconsin.

Record the full house number (including fractions, if any).

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 address. A 5-digit zip is acceptable.

You may not enter a PO Box as a residential address. A rural route box without a number should not be used.

If your mailing address is different from your home address, provide it here. A PO Box is acceptable as a

mailing address. Overseas electors should provide their complete overseas address.

If your name has changed, provide your previous first, last and middle names, along with a suffix, if any.

Provide this information regardless of the time elapsed since your last name change.

If your residential address has changed, provide your previous address here.

Provide this information whether you moved within Wisconsin or from another state regardless of time elapsed.

Answer both questions by filling in the appropriate circle. If you answer “No” to either question, you are not

eligible to vote in Wisconsin.

Please note, for Question 2, you must either be at least 18 years old, or will be at least 18 years old at the time

of the next election to be eligible to vote.

Please read carefully. By filling in this circle you are certifying that you meet the eligibility requirements to vote.

If you do not meet these requirements, you are not eligible to vote in Wisconsin, and do not fill in this circle.

If you need assistance when voting, describe the assistance required (e.g. wheelchair access).

If you are interested in being a poll worker for your municipality, fill in the circle.

If you do not have a street address, use the map to show where you live.

By signing and dating this form, you certify that all the information you have provided on this form is true and

correct, and that you meet the eligibility requirements for voting, listed in the statement in Box 9 of this form.

Corroborator: If you are registering on Election Day or after the official close of registration (5 pm on the 20th day before an election), you

must provide proof of residence. If you are unable to do so, another qualified elector of the municipality may do so on your behalf. That

corroborator must record his or her signature and address on the form in the space provided.

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.

EB-131 INSTRUCTIONS (SHADED, WITHOUT HASHMARKS) (REV 10/2008)

Wisconsin Voter Registration Application Page 2

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