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, you will not be registered to vote.

Your eligibility to vote

Yes

If you answered "No", do not complete this form.

Are you a citizen of the United States?*

Helping with elections

I would like to be an election judge.

Yes

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

Address where you would like your ballot mailed (if different from your home or mailing address)

Address

Apt. or Unit

City or Town

State

ZIP Code

Your phone number

Area code

Phone number

Election information by email

Email address

If you select this option, you will receive upcoming election information by email.

I would like to receive election information by email.

Yes

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

Democratic

Green

Libertarian

Republican

Unaffiliated

Sign or mark below

Warning:

A violation of the self-affirmation you are about to make is a criminal act under the laws of this state and will subject you to the penalties provided by law.

It is a Class 1 Misdemeanor to swear or affirm falsely as to your qualifications to vote.

Self-Affirmation:

I affirm that I am a citizen of the United States, I have been a resident of the state of Colorado for at least 22 days, I am at least sixteen years old and understand that I must be

eighteen years old to be eligible to vote, I meet the registration qualifications and that the information I have provided on this application is true to the best of my knowledge

and belief, and I further affirm that I will not cast more than one ballot in any election. I am aware that if I register to vote in Colorado I am also considered a resident of

Colorado for motor vehicle registration and operation purposes and for income tax purposes. I further affirm that my present address as stated herein is my sole legal place of

residence and that I claim no other place as my legal residence.

Date*

Signature or Mark*

Witness Signature

Date*

(If you are unable to sign, you must make a mark and a witness to the mark

must sign here).

Print Form

SOS Approved 8-7-13

[Article 2, Title 1, C.R.S.]]