Missouri Voter Registration Application Form – Fill Out and Use This PDF

MISSOURI VOTER REGISTRATION APPLICATION

Use this application to:

1.Register to vote in any election in Missouri.

2.Register to vote when you move from one jurisdiction (St. Louis City, Kansas City, or any county) to another jurisdiction (St. Louis City, Kansas City, or any county) within Missouri.

3.Change the address on a current voter registration when you move within a jurisdiction.

4.Change the name on a current voter registration.

Other information:

1.You must be 18 years of age by the day of a particular election to be eligible to vote in that election.

2.If mailed, this form must be postmarked by the 4th Wednesday preceding an election to be eligible to vote in that election. If delivered in person, it must be received in the office of the election authority by the 4th Wednesday preceding an election. (See reverse for election calendar.)

3.Submitting this application to an individual other than the election authority does not insure timely voter registration.

4.After the election authority receives your voter registration application, you will be sent confirmation within 7 business days. If you do not receive confirmation, contact the election authority.

5.If you wish to serve as an election judge on election day please contact your local election authority and mark the box at the bottom of this form.

6.Optional—If registering by mail for the first time, please submit a copy of one of the following forms of identification: current or valid photo ID, current utility bill, bank statement, government check, paycheck or other government document that shows your name and address, birth certificate, Native American tribal document or other proof of United States citizenship. (You will be required to present identification when you vote.)

Completing this form (All information is required unless indicated as optional): Boxes 1 and 2 -- Citizen and Age Requirements

Federal Law requires voter registration applicants to answer these two questions.

Box 3 -- Type of Application

Check appropriate box if this is a new registration or if you are changing a name or address on your current voter registration.

Box 4 -- Name

Put in this box your full name (Last, First, Middle). DO NOT use nicknames or initials. For name changes, Box 12 should contain your old name.

Box 5 -- Home Address

List your home address. DO NOT put your mailing address if it differs from your home address.

Box 6 -- Mailing Address

If you get your mail at an address other than your home address in Box 5, put that address here in this box.

Box 7 -- Driver’s License Number

Required for registration unless you do not have a Driver’s License. (§115.158, RSMo.) If you do not have a Driver’s License, leave blank.

Box 8 -- Last Four Digits of Social Security Number

Required for registration unless you do not have a Social Security Number. (§115.155, RSMo, §115.158, RSMo.) If you do not have a Social Security Number, leave blank.

Box 9 -- Date of Birth

Place your date of birth in this box (Month, Day, Year). DO NOT USE TODAY’S DATE!

Box 10 -- Place of Birth (Optional)

List your place of birth (city/county/state).

Box 11 -- Daytime Phone Number (Optional)

Please list a number at which the election authority may contact you for clarification of information.

Box 12 -- Last Voter Registration Information

If you are currently registered, please list the name and address of your last regis- tration including county and state.

Box 13 -- Signature

Review the information. If you meet the requirements and all is correct, sign your full name or make your mark and print today’s date.

Box 14 -- Rural Voters

If you live in a rural area without a street address, please supply information which may help in placing you in the proper voting district.

MISSOURI VOTER REGISTRATION APPLICATION

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