Tennessee Mail-In Application For Voter Registration
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2Tennessee Mail-In Application For Voter Registration
You can use this form to:
register to vote in Tennessee or to change your name and/or address.
Are you interested in working on
To register to vote:
Election Day? ☐ Yes
☐ No
you must be a U.S. citizen, AND
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 voting rights must have been restored.
If you register by mail, you must vote in person the first time you vote after registering.
MAIL OR HAND DELIVER THIS FORM TO YOUR COUNTY ELECTION COMMISSION.
Go to:
to find your County Election Commission address.
Instructions / checklist:
☐ Please PRINT with a blue or black INK pen (not felt tip).
☐ Provide the information in boxes 1-10 below, read and answer the VOTER DECLARATION in box 11, and sign by the
“X” in box 12.
☐ 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, excluding social security
numbers.
☐ To ensure a more confidental mailing process of this form, the applicant is encouraged to place the voter
registration application in an envelope addressed to the county election commission.
Names of persons selected for jury service in state court are not chosen from permanent voter registration records.
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 registration card. This card will tell you where to vote.
Federal or Tennessee State Government Issued Photo ID Is Required To Vote Unless Exception Applies.
1
FOR COUNTY ELECTION COMMISSION USE ONLY
Are you a citizen of the United States? ☐ Yes ☐ No
Mail
Reg #
Approved
Will you be 18 years of age or older on or before Election Day? ☐ Yes ☐ No
Effective Date
P/A
If you answered "No" in response to either of the above,
District
Precinct
Ward
do not complete this form.
2
LAST NAME
FIRST NAME
MIDDLE NAME
SUFFIX
3
SEX
4
RACE
(OPTIONAL)
☐
☐
M
F
5
ADDRESS WHERE YOU LIVE (DO NOT GIVE A P.O. BOX)
APT. #
CITY
COUNTY
STATE
ZIP CODE
6
ADDRESS WHERE YOU GET YOUR MAIL (IF DIFFERENT THAN ABOVE)
7
E-MAIL (OPTIONAL)
8
(required under T.C.A. § 2-2-116 for
9
DATE OF BIRTH
CITY AND STATE OF BIRTH
SOCIAL SECURITY #
PHONE #
purposes of identification and to
avoid duplicate registration)
10
NAME AND ADDRESS ON LAST VOTER REGISTRATION
NAME
ADDRESS
CITY
COUNTY
STATE
ZIP
11
12
VOTER DECLARATION: I, being duly sworn on oath (or
WARNING: Giving false information to register to vote or attempting to register
affirmation) declare that the above address is my legal residence
when not qualified is a felony punishable by not less than two (2) years nor more
than twelve (12) years imprisonment or a fine of $5,000 or both.
and that I plan to remain at such residence for an undetermined
period of time and say that to the best of my knowledge and
X
belief all of the statements made by me are true.
Signature (or mark) of Applicant
Date
Yes
No
____
____
1. Are you a resident of the State of Tennessee?
If applicant is unable to sign, provide signature of person who signed for applicant.
2. Have you ever been convicted of a crime which
is a felony in this state, by a court in this state,
Signature of Person Assisting
____
____
a court in another state, or a federal court?
Address
ss-3010 (Rev. 10/15)
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