Fillable Texas Voter Registration Application printable pdf download

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use of fillable PDF forms. Use of incompatible browsers will require you to download the form and either print it or fill

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in use. You can also use the Texas SOS VR Form:

https://webservices.sos.state.tx.us/vrapp/index.asp.

Please return completed applications to Tarrant County Elections, 2700 Premier Street, Fort Worth, TX 76111-3011.

If returning by mail, please place application in an envelope and affix the proper postage.

Please read and follow all instructions carefully. If you have questions, please contact the Tarrant County Elections

Department at 817-831-8683.

Texas Voter Registration Application

For Official Use Only

RESET FORM

Prescribed by the Office of the Secretary of State

VR17.2016E.I3

Please complete sections by printing LEGIBLY. If you have any questions about how to fill out this application, please

call your local voter registrar.

These Questions Must Be Completed Before Proceeding (

Check One)

New Application

Change of Address, Name, or

Request for a Replacement Card

Other Information

Are you a United States Citizen?

Yes

Will you be 18 years of age on or before election day?

Yes

If you checked 'No' in response to either of the above, do not complete this form.

Are you interested in serving as an election worker?

Yes

Last Name

First Name

Middle Name

Former Name

Include Suffix if any

(If any)

(Jr, Sr, III)

Residence Address:

City

Street Address and Apartment Number. If none,

TEXAS

describe where you live. (Do not include P.O. Box, Rural Rt. or Business Address)

County

Zip Code

City

State

Mailing Address

Street Address and Apartment Number. (If mail cannot

be delivered to your residence address.)

Zip Code

City and County of Former Residence in Texas

Date of Birth:

Gender

Telephone Number

(mm/dd/yyyy)

(Optional)

Include Area Code

Male

(

)

Female

Texas Driver's License No. or Texas Personal

If no Texas Driver's License or Personal

I.D. No.

Identification, give last 4 digits of your Social

(Issued by the Department of Public Safety)

Security Number

XXX-XX

I have not been issued a Texas Driver's License/Personal Identification Number or

Social Security Number.

I understand that giving false information to procure a voter registration is perjury, and a crime under state and

federal law. Conviction of this crime may result in imprisonment up to 180 days, a fine up to $2,000, or both.

Please read all three statements to affirm before signing.

•

I am a resident of this county and a U.S. citizen;

•

I have not been finally convicted of a felony, or if a felon, I have completed all of my punishment including

any term of incarceration, parole, supervision, period of probation, or I have been pardoned; and

•

I have not been determined by a final judgment of a court exercising probate jurisdiction to be totally

mentally incapacitated or partially mentally incapacitated without the right to vote.

Date

Signature of Applicant or Agent and Relationship to Applicant or Printed Name of Applicant if Signed by Witness and Date.

VR17.2016E.I3

Texas Voter Registration Application

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