State Of Iowa Official Voter Registration Form

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S
I
O
V
R
F
 
TATE OF 
OWA 
FFICIAL 
OTER 
EGISTRATION 
ORM
Revised 4/7/2016
In Iowa, you are not qualified to vote if you have been convicted of a felony and have not received a 
restoration of voting rights. You may apply to the Governor to restore your voting rights. 
1.
Are you a citizen of the United States?
Yes 
No 
Qualifications
2.
Will you be 18 years of age on or before Election Day?
Yes  
No
 
If you answered “No” to either of these questions, do not complete this form.
ID Number 
IA driver’s license #:  
Provide your Iowa 
 
driver’s license, non‐
IA non‐operator ID #: 
operator ID number, 
or the last 4 digits of 
Last 4 digits of Social Security number:    XXX – XX –  
your Social Security 
number if you have 
I do not have an IA driver’s license, non‐operator ID, or Social Security number. 
one. 
 
Additional 
Date of Birth 
    
    /    
  /
(month, day, year)
 
Information
 
Sex
 
Male 
Female 
 
Date of birth and 
sex are required. 
Phone and/or Email
 (optional)
Last
Your Name 
 
First  
 
Middle
Suffix
Street Address
 
Address 
 
(include apt., lot, etc.)
 
Where You 
City 
Zip 
County 
 
Live 
If homeless or you do not have an established residence, describe where you reside: 
Where You 
  
 
Address/P.O. Box
Receive Mail 
City 
State 
Zip 
(if different) 
Previous 
Your name was 
Voter 
Your address was 
Registration 
Information 
Your city and state were
Your zip was 
Political 
 
Political Parties: 
No Party   
Democratic 
Republican
Affiliation 
Non‐Party Political Organizations: 
Green  
Libertarian 
(check only one) 
WARNING 
Registrant Affidavit
If you sign this 
I swear or affirm under penalty of perjury that: 
form and you 
 I am the person named above.
know the 
 I am a citizen of the United States.
information is 
 I have not been convicted of a felony (or I have received a restoration of rights).
not true, you 
 I am at least 17 ½ years old.
may be 
 I live at the address listed above.
convicted of 
 I am not currently judged by a court to be “incompetent to vote.”
perjury and 
 I do not claim the right to vote anywhere else.
fined up to 
$7,500 and/or 
jailed for up to 
5 years. 
Signature
Date 

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