Request For Disability Exemption Form printable pdf download

13-6

Prescribed by Secretary of State

Sections 13.002(i), 63.001(b), 63.0101, Texas Election Code

1/2016

REQUEST FOR DISABILITY EXEMPTION

To the Voter Registrar:

Pursuant to Section 13.002(i) of the Texas Election Code, I hereby request a permanent exemption in this county

from the requirement to present identification other than the voter registration certificate at the time of voting on the

ground that I have a disability and do not have any of the forms of identification listed in Section 63.0101 of the

Texas Election Code. The acceptable forms of identification are: a driver’s license, election identification

certificate, personal identification card or handgun license issued by the Texas Department of Public Safety;

United States Military identification card containing the person’s photograph; United States citizenship

certificate containing the person’s photograph; or United States passport, and with the exception of the United

States Citizenship certificate, the identification presented for voter qualification at the polling place must be current

or have expired no more than 60 days before it is presented.

I have attached written documentation from the United States Social Security Administration evidencing that I have

been determined to have a disability or from the United States Department of Veterans Affairs evidencing that I have

at least a 50 percent disability rating. I understand that the voter registrar will maintain this documentation with other

records pertaining to my registration in this county, and that the exemption cannot be granted without this

documentation. I further understand that if I move to a new county and register to vote in that county, I will have to

submit a new disability exemption request and supporting documentation to the county in which I am registering.

Name

Residence Address (number and street)

City, State, Zip Code

VUID Number

County of Residence

I certify that the information in this document is true and correct.

Sign

Here► _____

__________________________________________

Date ►___

_________________________________

Assistant/Witness

If voter cannot sign, voter’s mark must be witnessed. If voter cannot make a mark, witness must check here_____. If

the voter is unable to read and/or mark this form, the witness must fill out the information below.

X____

___________________________________________

/ ____

___________________________________________

Printed name and Signature of Witness

_________________________________________________________________________________________________

Residence Address of person named above or title if being witnessed by the voter registrar’s office.

□

For Office

VUID # ___

_______________

Proof of Disability Submitted?

Yes

Use Only

Voter Reg. Dept. Signature ________________________________________

Date_________________

Comments: ________________________________________________________________________

Request For Disability Exemption Form

Related Articles

Related forms

Related Categories