Fillable Florida Voter Registration Application Form printable pdf download

Florida Voter Registration Application

Información en español: Sirvase llamar a la oficina del supervisor de

Part 1 – Instructions (DS-DE 39, R1S-2.040, F.A.C.)(eff. 10/2013)

elecciones de su condado si le interesa obtener este formulario en español.

To Register in Florida, you must be:

Where to Register: You can register to vote by completing this application and delivering it in person or by mail to

any supervisor of elections’ office, office that issues driver’s licenses, or voter registration agency (public assistance

• a U.S. citizen,

office, center for independent living, office serving persons with disabilities, public library, or armed forces recruitment

• a Florida resident,

office) or the Division of Elections. Mailing addresses are on page 2 of this form.

• at least 18 years old (you may pre-register at 16 or 17,

Deadline to Register: The deadline to register to vote is 29 days before any election. You can update your

but cannot vote until you are 18).

registration record at any time, but for a Primary Election, party changes must be completed 29 days before that

If you have been convicted of a felony, or if a court has

election. You will be contacted if your new application is incomplete, denied or a duplicate of an existing registration.

found you to be mentally incapacitated as to your right to

Your Voter Information Card will be mailed to you once you are registered.

vote, you cannot register until your right to vote is restored.

Identification (ID) Requirements: New applicants must provide a current and valid Florida driver’s license number

If you do not meet any ONE of these requirements, you

(FL DL#) or Florida identification card number (FL ID#). If you do not have a FL DL# or FL ID#, then you must provide

are not eligible to register.

the last four digits of your Social Security number (SSN). If you do not have any of these numbers, check “None.” If

Questions?

you leave the field and box blank, your new registration may be denied. See section 97.053(6), Fla.Stat.

Special ID requirements: If you are registering by mail, have never voted in Florida, and have never been issued one

Contact the Supervisor of Elections in your county:

of the ID numbers above, include one of the following with your application, or at a later time before you vote: 1) A

copy of an ID that shows your name and photo (acceptable IDs--U.S. Passport, debit or credit card, military ID,

Visit the Florida Division of Elections’ website at:

student ID, retirement center ID, neighborhood association ID, or public assistance ID); or 2) A copy of an ID that

shows your name and current residence address (acceptable documents--utility bill, bank statement, government

check, paycheck, or other government document).

CRIMINAL OFFENSE:

It is a 3rd degree felony to submit

The special ID is not required if you are 65 or older, have a temporary or permanent physical disability, are a member

false information. Maximum penalties are $5,000 and/or 5

of the active uniformed services or merchant marine who is absent from the county for active duty, or a spouse or

years in prison.

dependent thereof, or are currently living outside the U.S. but otherwise eligible to vote in Florida.

PUBLIC RECORD:

Once filed, all information including your

Political Party Affiliation: Florida is a closed primary election state. In primary elections, registered voters can only

phone number and email address as provided become

vote for their registered party’s candidates in a partisan race on the ballot. In a primary election, all registered voters,

public record except for the following which can only be

regardless of party affiliation, can vote on any issue, nonpartisan race, and race where a candidate faces no

used for voter registration purposes: your FL DL#, FL ID#,

opposition in the General Election. If you do not indicate your party affiliation, you will be registered with no party

SSN, where you registered to vote, and whether you

affiliation. For a list of political parties, visit the Division of Elections’ website at:

declined to register or to update your voter registration

Race/Ethnicity: It is optional to list your race or ethnicity.

record at a voter registration agency. Your signature can be

viewed but not copied. (Section 97.0585, Fla. Stat.)

Boxes: Please check boxes () where applicable.

Numbered rows 1 through 7 and 12 must be completed for a new registration.

Florida Voter Registration Application

The downloadable/printable online form is available at:

/for-voters/voter-registration

Part 2 – Form (DS-DE #39, R1S-2.040, F.A.C.)(eff. 10/2013)



This is:

New Registration

Record Update/Change (e.g., Address, Party Affiliation, Name, Signature)

Request to Replace Voter Information Card

OFFICIAL USE ONLY



Are you a citizen of the United States of America?

YES



I affirm that I am not a convicted felon, or if I am, my right to vote has been restored.



I affirm that I have not been adjudicated mentally incapacitated with respect to voting

or, if I have, my right to vote has been restored.

Date of Birth

(

MM-DD-YYYY)

FVRS No:

If no FL



Last 4 digits of Social

I have

Florida Driver License (FL DL) or Florida identification (FL ID) Card Number

DL or FL

Security Number

NONE of

ID, then

these

provide

numbers

Last Name

First Name

Middle Name

Name Suffix

(Jr., Sr., I, II, etc.):

Address Where You Live (legal residence-no P.O. Box)

Apt/Lot/Unit

City

County

Zip Code

Mailing Address (if different from above address)

Apt/Lot/Unit

City

State or Country

Zip Code

Address Where You Were Last Registered to Vote

Apt/Lot/Unit

City

State

Zip Code

Former Name (if name is changed)

Gender

State or Country of Birth

Telephone No. (optional)

(

)



Email me SAMPLE BALLOTS if option is available in my county.

(See Public Record Notice above) My email address is:

Party Affiliation

Race/Ethnicity (Check only one)

(Check only one if applicable)



I will

(Check only one. If left blank, you will



American Indian/Alaskan Native



I am an active duty Uniformed Services or Merchant

need

be registered without party affiliation)



Marine member

Asian/Pacific Islander

assistance



Florida Democratic Party

with voting.



Black, not of Hispanic Origin



I am a spouse or a dependent of an active duty uniformed



Republican Party of Florida



services or merchant marine member

Hispanic



I am

No party affiliation



White, not of Hispanic Origin



I am a U.S. citizen residing outside the U.S.

interested in



Minor party (print party name):



Multi-racial

becoming a

______________________

________________



poll worker.

Other:

Oath: I do solemnly swear (or affirm) that I will protect

Date

SIGN/

and defend the Constitution of the United States and

MARK

the Constitution of the State of Florida, that I am

HERE

qualified to register as an elector under the

Constitution and laws of the State of Florida, and that

all information provided in this application is true.

Florida Voter Registration Application Form

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