Virginia Voter Registration Application Form Page 4
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4Virginia Voter Registration Application Receipt
M
M
D
D
Y
Y
Y
Y
/
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Name of Applicant
Date
-
-
Name of group or individual
E-mail address
Daytime telephone number of group
receiving application
or individual receiving application
No receipt is required for application
On-line:
completed in the Voter Registration
Voice: 800 · 552 · 9745
Office.
Registration Application, please contact
TTY: 800 · 260 · 3466
the Virginia State Board of Elections.
Richmond local: 804 · 864 · 8901
SBE-416.2 Rev. 7/14
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