Application For Appointment As A Harris County Volunteer Deputy Voter Registrar Form
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1M
S
IKE
ULLIVAN
Tax Assessor-Collector & Voter Registrar
APPLICATION FOR APPOINTMENT AS A
HARRIS COUNTY VOLUNTEER DEPUTY VOTER REGISTRAR
2015 – 2016 TWO YEAR APPOINTMENT EXPIRES DECEMBER 31, 2016
THIS DEPUTIZATION IS VALID IN AND FOR HARRIS COUNTY ONLY
Please print clearly. Black or blue ink only.
VUID (Optional): ____________________
VOTER CERT. NO. (Optional): ___________________
NAME: Last ___________________ First ______________________ Middle__________________
RESIDENCE ADDRESS: _____________________________________________________________
City
State
Zip
MAILING ADDRESS: ________________________________________________________________
City
State
Zip
DAYTIME TELEPHONE: _________________________ DATE OF BIRTH: _____/_____/______
E-MAIL ADDRESS: _________________________________________________________________
Are you currently a volunteer deputy in another county?
Yes
No
If yes, please provide county of appointment and deputy number: ____________________________
I understand that under Section 13.031 of the Texas Election Code, a Volunteer Deputy Registrar must (1) be 18 years of age or older; (2) not
have been finally convicted of a felony, or, if so convicted, must have (i) fully discharged the person’s sentence, including any term of
incarceration, parole, or supervision, or completed a period of probation ordered by any court, or (ii) been pardoned or otherwise released from
the resulting disability to vote; (3) not have been finally convicted of an offense under Section 32.51 of the Texas Penal Code (identity theft);
(4) be a United States citizen; (5) not have been determined by a final court judgment to be (i) totally mentally incapacitated, or (ii) partially
mentally incapacitated without the right to vote; and (6) a resident of the State of Texas. I affirm that I meet all the qualifications to be a
Volunteer Deputy Registrar.
I further understand that I may not accept any completed voter registration applications unless and until I complete the training program
mandated under Section 13.047 of the Texas Election Code and receive a Certificate of Appointment.
I further understand this appointment shall terminate if the appointee receives a final conviction for an offense for failure to deliver a voter
registration application (Section 13.008 of the Texas Election Code) or an offense relating to performance based compensation (Section 13.043
of the Texas Election Code), and may terminate if the voter registrar determines that the appointee failed to adequately review a voter
registration application, intentionally destroyed or altered an application, or engaged in other conduct that conflicts with their duties as a
Volunteer Deputy Registrar.
I understand that if I have been terminated as a Volunteer Deputy Registrar because of a final conviction for performance-based compensation
for registering voters or failure to deliver a voter registration application, I may not be reappointed as a Volunteer Deputy Registrar.
SIGNATURE OF APPLICANT: __________________________________ DATE: ________________
VTR – VDVR
Rev 11/23 v8
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