Fillable Maryland Voter Registration Application printable pdf download

After This Form Is Filled Out, You Must Sign And Mail It To Your County Board of Elections. It

Cannot Be Processed If It Is Faxed or E-mailed, Because It Requires An Original Signature.

MARYLAND VOTER REGISTRATION APPLICATION

TO REGISTER, YOU MUST

DEADLINE INFORMATION

Be a U.S. citizen;

This application must be received by a Maryland election oﬃce no later

■

Be a Maryland resident;

than 9

., 21 days before an election.

■

Be at least 18 years old by the next General Election;

If your application is complete and you are found to be qualiﬁed, a Voter

■

Not be under guardianship for mental disability;

Notiﬁcation Card will be mailed to you.

■

Not have been convicted of buying or selling votes;

You are not registered until you receive your Voter Notiﬁcation Card.

■

Not have been convicted more than once of a crime of violence (Criminal

The submission of this form to an individual other than an oﬃcial, em-

■

Law Article §14-101);

ployee, or agent of a County Board of Elections does not assure that the

Not have been convicted of an infamous crime (any felony or other crime

form will be submitted or ﬁled in a timely manner.

■

involving deceit, fraud, or corruption), unless;

You have been pardoned, OR

TO RETURN THIS FORM

You have completed the court-ordered sentence imposed (ﬁrst conviction), OR

Complete Items 1-12 in Voter Registration Application. Sign and date Item

■

At least 3 years have passed since you completed the court-ordered

13. If you are registered to vote in another Maryland county or another

sentence imposed (second or later conviction).

state, you must complete Items A-B in Last Voter Registration.

Address the application to your County Board of Elections, using the list on

■

YOU CAN USE THIS FORM TO

the instruction page.

■

Change your name, address, or party aﬃliation.

■

VOTER REGISTRATION APPLICATION

Check boxes that apply and complete Items 3-13.

Yes

Will you be at least 18 yrs old on or by the next General Election?

New Registration

Party Aﬃliation Change

Are you a U.S. citizen?

Yes

Name Change

Address Change

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

Last Name

Title (Jr., Sr., etc.)

First Name

Middle Name

Driver’s License or MVA ID Number - MANDATORY

Check here if you do not have either a current, valid Maryland

(If you have neither, see instructions.)

driver’s license / MVA ID card or a Social Security number.

Check here

Maryland

Street Number

Street Name

Apt. No.

City or Town

Zip Code

County

Residence

if you reside

in Baltimore

Address:

Mailing Address (if diﬀerent from Item 5):

Month

Date

Year

Daytime Phone:

Birth

Sex:

Male

Female

Date:

Party (check one):

Democrat

Republican

Green

Constitution

Libertarian

Populist

Unaﬃliated

Other-Specify:______________________________________________

(decline to join a party)

Check here if you would like information on polling place assistance

Check here if you would like information on working as

for elderly, disabled, or voters unable to write or read the ballot.

an election judge for your County Board of Elections.

Under penalty of perjury, I hereby swear or aﬃrm: I am a U.S. citizen. I am a Maryland resident. I will be at least 18 years old by the next General Election. I am not under

guardianship for mental disability. I have not been convicted of buying or selling votes. I have not been convicted more than once of a crime of violence. I have not been

convicted of an infamous crime (unless I have been pardoned or, for a ﬁrst conviction, I have completed my sentence, or, for a second or later conviction, 3 years have passed

since I completed my sentence). The information in this application is true to the best of my knowledge, information, and belief.

Signature (required)

Date

DO NOT WRITE IN SPACE BELOW

REG. CODE

CLERK’S INITIALS

CONTROL NUMBER

VOTER ID

DISTRICT

PRECINCT

WARD

MONTH