Form Vr-154 - Application For Maryland Change Of Address printable pdf download

Motor Vehicle Administration

VR-154 (06-16)

6601 Ritchie Highway, N.E.

Glen Burnie, Maryland 21062

Application for Maryland Change of Address

UNITED STATES GOVERNMENT EMPLOYEES SHOULD USE FORM VR-102 TO CERTIFY A TEMPORARY OUT-OF-STATE ADDRESS.

Please complete in ink. All applicants must complete Section A. Complete Section B to apply to register to vote in Maryland. If you are already

registered to vote in Maryland, you can use Section B to indicate that you do not want your voter registration address updated or to change your

party affiliation. For additional instructions, see back of form.

Driver’s

Date

License/

Soundex

Birth

Number

First:

Middle:

Last:

Title (Jr., Sr., etc.):

Name:

Old

New

Resident

Address

County:

State:

County:

State:

City:

Zip:

City:

Zip:

Title Number:

Tag Number:

Sticker Number:

Certification: I hereby certify, under penalty of perjury, that the statements made on this form are true and correct to the best of my knowledge, information, and belief.

Full Signature

Date:

(required):

If you are already registered to vote in Maryland, the information in Section A will automatically update your voter registration information.

❒

Check here if you do not want your voter registration updated.

If you are already registered to vote in Maryland and you only want to change your party affiliation, complete Items 3, 9, 13, and 14.

If you are NOT registered to vote in Maryland, and you would like to apply to register to vote, complete Items 2 - 14. You Must be a U.S. Citizen.

❒

Check boxes that apply and complete Items 4-14:

Are you at least 16 years old?

Yes

❒

New Registration

Party Affiliation Change

ARE YOU A U.S. CITIZEN?

Yes

❒

If you answer NO to either question, do not complete this form.

Address Change

Mailing address (if different

from residence address

above in section A):

Month

Day

Year

Birth

❒

Gender:

Daytime Phone:

Male

Female

Date:

Social Security Number:

(Voluntary. See Instructions in section D):

Party:

YOU MUST REGISTER WITH A POLITICAL PARTY

❒

Democrat

Republican

Libertarian

Green

IF YOU WANT TO TAKE PART IN THAT POLITICAL

PARTY’S PRIMARY ELECTION, CAUCUS, OR

❒

Unaffiliated (independent of any party)

Other – Specify:

CONVENTION. CHECK ONE BOX ONLY.

❒

Check here if you need help voting.

Check here if you would like to be an election judge.

Under penalty of perjury, I hereby swear or affirm: I am a U.S. citizen • I am a Maryland resident • I am at least 16 years old • I have not been convicted of buying or

selling votes • I have not been convicted of a felony, or if I have, I have completed serving a court-ordered sentence of imprisonment. The information in Section B of

this application is true to the best of my knowledge, information, and belief.

Full Signature (required)

Date

DO NOT WRITE IN SPACE BELOW

CONTROL NUMBER

Address on Last

REG. CODE

CLERK’S INITIALS

Street Number

Street Name

Registration

(if applicable):