Maryland Voter Registration Application Form
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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
YOu CAN use ThIs fORM TO
n Be a U.S. citizen;
n Register to vote in federal, state, county, and municipal elections in
n Be a Maryland resident;
Maryland.
n Be at least 16 years old*;
n Change your name, address, or party affiliation.
n Not be under guardianship for mental disability or if you are, you have
INsTRuCTIONs
not been found by a court to be unable to communicate a desire to
n If you do not have a current, valid Maryland driver’s license or MVA ID
vote;
card, you must enter the last 4 digits of your social security number.
n Not have been convicted of buying or selling votes;
The statutory authority allowing officials to request the last 4 digits
n Not have been convicted of a felony, or if you have, you have
of your social security number is Election Law Article, § 3-202. The
completed serving a court-ordered sentence of imprisonment,
number will only be used for registration and other administrative
including any term of parole or probation for the conviction.
purposes. It will be kept confidential.
*you may register to vote if you are at least 16 years old but cannot vote
n Complete Items 1–11 in Voter Registration Application. Sign and date
unless you will be at least 18 years old by the next general election.
Item 12. If you are registered to vote in another Maryland county or
DeADLINe INfORMATION
another state, you must complete Items A–B in Last Voter Registration.
n This application must be postmarked no later than 21
n you must register with a party if you want to take part in that party’s
days before an election.
primary election, caucus or convention. Check one box only.
n If your application is complete and you are found to be qualified, a
n Address and mail the application to your County Board of Elections,
Voter Notification Card will be mailed to you.
using the list on the back panel.
n The submission of this form to an individual other than an official,
employee, or agent of a County Board of Elections does not assure
that the form will be submitted or filed in a timely manner.
BLACK
VOTeR RegIsTRATION AppLICATION pLeAse COMpLeTe IN
INK
l Yes l No
Are you at least 16 years old?
1
l Yes l No
Are you a U.S. citizen?
If you answer NO to either question, do not complete this form.
Check boxes that apply and complete Items 3–12.
2
l New Registration
l Name Change
l Party Affiliation Change
l Address Change
Last Name
First Name
Middle
Suffix
3
Sex: l Male
l Female
4
5
Month
Date
Year
Birth Date:
MARYLAND Driver’s License or MVA ID Number MANDATORY
6a
(If you have neither see instructions)
l Check here if you do not have either a current, valid Maryland
Social Security Number (last 4 digits)
6b
6c
driver’s license / MVA ID card or a Social Security Number
Maryland
Street Number
Street Name
Apt. No.
City or Town
Zip Code
County
7
Residence
l Check here if you reside in Baltimore City.
Address:
Mailing Address
8
(if different from Item 7)
l Democratic Party
l Republican Party
l Green Party
l Libertarian Party
Party (check one):
9
l Unaffiliated (independent of any party)
l Other – Specify __________________________________
CONTACT INfORMATION
10
Daytime Phone:
Email (optional):
l Check here if you would like information on polling place assistance for elderly, disabled or voters unable to write or read the ballot.
11
l Check here if you would like information on working as 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 am at least 16 years old.
I have not been convicted of buying or selling votes.
I have not been
n
n
n
n
convicted of a felony, or if I have, I have completed serving a court-ordered sentence of imprisonment, including any term of parole or probation for the conviction. The information in this application is
true to the best of my knowledge, information and belief.
Signature (required)
Date
12
X
LAsT VOTeR RegIsTRATION INfORMATION (if applicable)
Name
Last Name
Title (Jr., Sr., etc.)
First Name
Middle Name
Date of Birth
A
on Last
Registration:
Address
Street Number
Street Name
Apt. No.
City or Town
Zip Code
State
B
on Last
Registration:
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