Mail-In Voter Registration Application
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1
2Mail-In Voter Registration Application
West Virginia
QUESTIONS?
Box 4.
Provide residence & mailing addresses. If
You Can Use This Form To:
(required)
the address where you live does not
apply to register to vote in West Virginia
Go to or
change your address or name on your voter record
include a street name & number, describe
CALL TOLL FREE 1-866-SOS-VOTE
change your political party on your voter record
where you live by giving a road number,
West Virginia Secretary of State
intersection, or landmark to help identify
Follow These Steps To Complete Form:
your precinct. For military, overseas, or
Registration Deadline:
Note: If available, use black ink & print.
students, list your military / school
You may register at any time. In order to
Give your legal name--(last name, first name,
address as your mailing address & your
Box 1.
legal West Virginia address for the
(required)
middle or maiden name--no nicknames)
vote in an election, you must be registered
residence address. Provide a mailing
twenty-one (21) days before that election.
address if it is different than where you
Box 2.
Give your birth date--(month/day/year).
Mailing Directions:
live.
(required)
Box 5.
Box 3.
Enter your driver's license number. If you do
Mark if you live within city limits.
Provide all required information (1, 2, 3, 4
not have a driver's license number, enter the
Give the telephone number where you can
(required)
Box 6.
& 10) before mailing form to county clerk.
last four numbers of your social security
be reached during the day.
number. If you do not have a driver's license
Box 10.
Check applicable boxes & sign your
Box 7.
Circle "M" for male or "F" for female.
(required)
number or a social security number, an
name if you meet these requirements.
Box 8.
Mark the party of your choice, list another
identification number will be assigned to you.
Signature must match the name given
party on the line provided, or
If this form is submitted by mail & it is the first
in Box 1. Note: It is a felony to sign
mark the "No Party Choice" box. (Please
time you have registered to vote in this
this form if you know you do not meet
note: mark "No Party Choice" if you wish
county, you MUST submit a copy of a current
the requirements listed in Box 10.
to be an "independent" or no party.) You
and valid ID with this application or at the polls
Box 11.
If you were registered before, enter
may vote a party primary
the first time you vote. To send it with this
your full name & complete address as
ballot only if you are registered with that
application you should enclose one of the
they were on your last registration.
party. However, some parties may allow
following:
voters who are not registered with their
Motor Voter registrants please note: If you decline
(1) A copy of a current & valid photo ID with
party to vote their party's ballot upon
to register to vote, your decision will remain
current residence address or
request.
confidential. When you register to vote, your
(2) A copy of a current utility bill, bank
information will remain confidential and may be
Box 9.
Check if this is a new registration, a name/
statement, government check, paycheck, or
used only for voter registration purposes.
address change, or a party change.
other government document that shows your
name and current residence address.
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