Voter Register At Ion Form

North Carolina Voter Registration Application/Update Form A. Information If you are not sure if you are registered, call your county board of elections office.

You can use this form to: Register to vote in your county of residence in North Carolina or change your voter information.

Qualifications: • You may only register to vote in the county where you reside. • You must be a US citizen by birth or naturalization. • You must be 18 years of age by the next general election. • If you have been convicted of a felony, your rights of citizenship must be restored. Requirements: • Complete the sections below by printing legibly. • Information required to process this application includes: name, residence address, date of birth, and signature. • You may mail or hand-deliver this form to the board of elections in the county where you live. If you choose to use this form to register to vote, the location where you have received this form will remain confidential and will be used only for voter registration purposes. If you declined to be registered to vote, the fact that you so declined will remain confidential and will be used only for voter registration purposes. Please detach before mailing

B. Cancel Your Previous Registration (in another County or State) If you were previously registered to vote in another county or State, you must fill out the information below to cancel your prior registration. Name: ________________________________________________

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If you live in a rural or nontraditional place, please show below where you live. Include street names and house numbers. Cross streets and landmarks are helpful.

Previous Name: _________________________________________ Previous Address: _______________________________________ ______________________________________________________ Previous City/State/ Zip Code: _____________________________ County of Previous Residence: ____________________________ Date of Birth: ____/____/______ Place of Birth: _______________ Signature: ________________________________________________________________

Date: ___/___/_____

In order to vote in an election, this form must be postmarked or delivered no later than the 25th day before that election. ................................................................................................................................................................................................................................ C. Application to Register to Vote (Print Information and Sign Below) New Registration Change of Information 1) Are you a citizen of the United States of America? yes no 2) Will you be 18 years of age on or before election day? If you checked “no” in response to either of these questions, do not complete this form.

Last Name:

First Name:

Middle Name:

Address where you now live (Number and Street/Road/Dorm):

Apt/Lot:

City:

County:

State: NC Zip:

Previous Name:

Previous Address (if you moved within the same county):

Date of Birth:

City and State of Birth:

Political Party Affiliation:

Gender:

You must register with a party to vote in that party’s primary unless that party allows unaffiliated voters to vote in its primary. If you indicate a political party that is not qualified or indicate no choice you will be listed as “Unaffiliated.”

Ethnicity: Hispanic/Latino (any race) Not Hispanic/Latino

Race: White Black or African American American Indian or Alaska Native Asian Two or More Races Other

Female

Male

no

Suffix (Sr., II):

Maiden Name:

Address where you get your mail (if different from above, also include zip code):

Democratic Republican Libertarian Unaffiliated Other Qualified Party: ________________________

yes

Telephone Number: (

)

(optional)

I attest , under penalty of perjury, that: 1.

I have been a resident of North Carolina, this county, precinct, ward, or other election district for 30 days before the next election I intend to vote in. 2. I am 18 years old, or will be at the time of the next general election. 3. I am a United States citizen. 4. I am not registered to vote or will not vote in any other county or state after submission of this voter registration form. I am canceling any voter registration I may have elsewhere. 5. If I have been convicted of a felony, my rights of citizenship have been restored. WARNING: If you sign this card and know it to be false, you can be convicted of a Class I Felony.

Signature:

Date:

Drivers License Number: If you do not have a Driver’s license, then list the last four digits of your Social Security Number:

.............................................................................................................................................................................................. IDENTIFICATION REQUIREMENT If you do not have a driver’s license or social security number, and this form is submitted by mail, and you have never registered to vote in the county you are now registering in, you must send, with this application, either a.) a copy of current and valid photo identification, or b.) a copy of a current utility bill, bank statement, government check, paycheck, or other government document that shows the name and address of the voter. If you do not provide the information requested above, you will be required to provide to election officials either a. or b. above the first time you vote at a voting place or by absentee ballot.

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - [Print this form. Fill it out completely. Place it in an envelope with postage sufficient to mail. Address it to the county board of elections office in your county (www.sboe.state.nc.us/about/countyoff.htm).]