Fillable Colorado Voter Registration Form printable pdf download

Colorado Voter Registration Form

For office use only

Voter ID Number: ________________________

(*)

Fill out all fields marked with an asterisk

. Follow the instructions for other fields. If you do not

Date Stamp:

provide all of the required information, your application to register to vote will not be complete.

Your eligibility to vote

Yes

Are you a citizen of the United States?*

Will you be at least 18 years of age on or before the next Election Day?*

Yes

If you answered "No" to either of the above questions, do not complete this form.

Your name

Last name*

First name*

Middle name

If you are currently registered to vote with a different name, what is that name?

Your identifying information

Your gender

Female

Male

Your birthdate*

(MM/DD/YYYY)

You must select one of the following and provide the requested information*

I have a valid Colorado Driver's License or Colorado ID card (issued by the Dept. of Revenue) and that number is

I have not been issued a Colorado Driver's License or ID card, but I have a Social Security Number & the last 4 digits are

I do not have a Colorado Driver's License, ID card, or a Social Security Number.

Your contact information

Your home address

Street address (No P.O. Boxes)*

Apt. or Unit

City or Town*

ZIP Code*

Colorado County

When did you move to this address?*

(MM/DD/YYYY)

Address where you receive your mail (required if different from your home address)

Mailing address

Apt. or Unit

City or Town

State

ZIP Code

Your former address

If you are changing your registration to a new address, you must provide the address where you were formerly registered to vote.

Street address (No P.O. Boxes)

Apt. or Unit

City or Town

State

ZIP Code

Your phone number and email

Area code

Phone number

Email address

Select or change your political party affiliation

Select only one. (Required if you want to vote in a party's Primary Election or participate in a party caucus).

American Constitution

Americans Elect

Democratic

Green

Libertarian

Republican

Unaffiliated

Voting by mail - Do you wish to be designated as a permanent mail-in voter?

Yes, I want to be a permanent mail-in voter and automatically receive a mail-in ballot for all applicable elections.

No, I do not want to be a permanent mail-in voter and if my name is on the permanent mail-in list I want it removed.

No, but I would like a mail-in ballot for this year's statewide elections.

If you want mail-in ballots only for certain elections or have different mailing addresses during certain times of the year, you will need to fill out a separate Mail-in Ballot Application.

Helping with elections

I would like to be an election judge or poll worker.

Yes

Sign or mark below

A violation of the self-affirmation, of which you are about to make, is a criminal act under Colorado law and you will be subject to the penalties provided by law.

WARNING: It is a crime

Self-Affirmation: I do solemnly affirm that I am a citizen of the United States and that on the date of the next election I shall have attained the age of eighteen years and shall have resided in

to swear or affirm falsely

the state of Colorado at least 30 days and in my present precinct at least 30 days before the election. I further affirm that the present address I listed herein is my sole legal place of residence

as to your qualifications

and that I claim no other place as my legal residence. I am aware that I can only legally vote in one place in any election and if I register to vote in Colorado I am also considered a resident of

to register to vote.

Colorado for income tax and motor vehicle registration and operation.

Signature or Mark*

Date*

Witness Signature

Date

(If you are registering for a Mail-in Ballot and are unable to sign, you must make

a mark and a witness to the mark must sign here).

Print Form

SOS Approved 9/28/12

[Sections 1-2-204, 1-2-501, 1-8-104, C.R.S.]