South Carolina Voter Registration Form - Mail Application printable pdf download

Registration Number

SOUTH CAROLINA VOTER REGISTRATION

MAIL APPLICATION

Check One:

New Registration

Are you a citizen of the United States of America?

Yes

(Check above if moving from one county to another)

Will you be 18 years of age on or before election day? Yes

Address or name change within the same county

If you checked ‘NO’ in response to either of these questions,

DO NOT complete this form

Last

First

Suffix

NAME

Black/African

Native

Other

SOCIAL SECURITY NUMBER **

Male

White

American Asian

Hispanic American Specify

SEX

RACE

Female

Inside City Limits

Street

Apt Number

ADDRESS

Yes

WHERE YOU

LIVE

City

State

Zip Code

Would you like to be a poll worker?

Yes

(Physical Address)

Street or Post Office Box

MAILING

ADDRESS

City

State

Zip Code

(if different

from above)

Month

Day

Year

Home

Work

BIRTHDATE

PHONE #

(

)

(

)

Precinct

County

State

REGISTRATION

Draw a dia gram of the area in w hich you li ve. Show your house in

Voter Declaration – (read and sign below)

relation to local landmarks such as schools, churches, stores, etc. Be

I swear or affirm that:

sure to label the streets or roads.

-I am a citizen of the United States of America

-I will be 18 years of age on or before Election day

-I am a resident of South Carolina, this county and precinct

-I am not under a court declaring me mentally incompetent

-I am not confined in any public prison resulting from a conviction of a crime

-I have never been convicted of a felony or offense against the election laws OR

if previously convicted, I have served my entire sentence, including probation

or parole, or I have received a pardon for the conviction

-the address listed above is my only legal place of residence,

and I claim no other place as my legal residence

Signature

Date of Application

Whoever shall, willfully and knowingly, swear (or affirm) falsely in taking any oath required

by law shall be guilty of perjury and, on conviction, incur the pains and penalties of the offense.

If you are registering for the first time in this county, you

attach a copy of a current valid photo ID or a copy of a current utility bil l,

ID Required:

must

bank statement, paycheck or other government docu ment that shows your name and address in this county. If you do not provide t his identification now, you

will be required to provide this information when you vote. Voters who are age 65 and over, voters with disabilities, members of the U.S. Uniformed Services

or Merchant Marines and their families, and U.S. Citizens residing outside the U.S. are exempt from this requirement.

** Social Security Number is required by the S.C. Code of Laws 7-5-170. This number is used for internal purposes only and eliminates multiple

registrations by a single individual. Your Social Security Number is not released to any unauthorized individual.

For Voter Registration Board Use Only

ity

Mail City

Mail Co.

Township

Precinct

House

Senate

Council