Voter Registration Form
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RHODE ISLAND
VOTER REGISTRATION FORM
Please print clearly in ink. All information is required unless marked optional.
YOU MAY USE THIS FORM TO:
TO REGISTER TO VOTE IN RI YOU MUST BE:
A legal resident of Rhode Island.
Register to vote in Rhode Island.
Change your name and/or address on your registration.
A citizen of the United States.
Choose a political party or change parties.
At least 16 years of age.
(
You must be at least 18 years of age to vote on Election Day.)
INSTRUCTIONS
Box 2: REQUIRED. Rhode Island citizens who are at least 16 years of age
Box 5: A person may have only one legal residence. You must register from
may pre-register to vote using this form. If you fail to check either of
your legal residence. A post office box or rural route may only be
these boxes, this form will be returned to you. If you checked NO to
used as a "Mailing Address" in Box 6.
either of these statements, do not complete this form.
If you want to affiliate to vote, choose a party. If you leave Box 9
Box 9:
If you are registering to vote for the first time in Rhode Island by mail
blank, you will be listed as unaffiliated.
Box 3:
or if someone else turns this form in for you, it is REQUIRED that
you provide your driver's license number or state ID number issued
Box 10: You must SIGN and DATE the registration form. If you fail to sign
by the RI Department of Motor Vehicles (DMV). If you do not have
and date the form, it will be returned to you.
either, you must provide the last 4 digits of your Social Security
Number. If you do not provide the above information or it cannot be
Box 11: If you are updating your voter registration because you legally
verified, you will be required to provide identification to an election
changed your name, enter your previous legal name.
official before voting. Acceptable forms of identification are on the
Board of Elections website at or contact
Box 12: If you are updating your voter registration because of an address
your local Board of Canvassers (see reverse side of this form).
change, enter your previous address, even if out-of-state.
You will receive an acknowledgement receipt of this voter registration form within 3 weeks. If you do not receive it, contact your
local Board of Canvassers (see reverse side for list). For questions and deadlines relating to this form, visit the Board of Elections
website at or contact your local Board of Canvassers (see reverse side for list).
(This form may be reproduced)
1.
New Voter Registration
Address Change
Party Change
Name Change
Check Boxes that Apply:
2.
I am a U.S. Citizen and resident
3.
RI driver's license or ID Number:
Yes
No
of Rhode Island.
I am at least 16 years of age.
Yes
No
If you do not have a RI driver's license or ID,
(You must be at least 18 years of age to vote.)
enter last 4 digits of your social security number:
If you checked NO to either of these statements, do not complete this form.
If you do not enter either number, see instructions for Box 3.
4.
Suffix (if any) First Name
Middle Name
Last Name
(or initial)
5.
Apt.
City/Town
State
ZIP Code
Home Address (Do not enter a post office box)
RI
6.
City/Town
State
ZIP Code
Apt.
Mailing Address (If different from Box 5)
7.
8.
Date of Birth (mm/dd/yyyy)
Phone No./ E-mail Address (optional)
9.
Party Affiliation:
Democrat
Moderate
Americans Elect
Republican
Unaffiliated
Other_______________________
Month
Day
Year
Official Use For Barcode
10. I swear or affirm that:
- I am not incarcerated in a correctional facility upon a felony conviction.
- I am not presently judged "mentally incompetent" to vote by a court of law.
- The information I have provided is true to the best of my knowledge under
penalty of perjury. If I have provided false information, I may be fined, imprisoned,
or (if not a U.S. citizen) deported from or refused entry into the United States.
PLEASE SIGN FULL NAME OR PLACE MARK BELOW
Are you interested
in working
at the polls?
Date:
(mm/dd/yyyy)
(check box below)
Signed
Warning: If you sign this form and know it to be false, you can be convicted and fined up to $5,000 or jailed up to 10 years.
12.
11. PREVIOUS NAME (if different from Box 4)
PREVIOUS ADDRESS OF REGISTRATION (City/Town, State, ZIP & County)
2/2012
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