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Arizona Voter Registration Form

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Arizona Voter Registration Form
Arizona Voter Registration Form
ARIZONA VOTER REGISTRATION FORM
FORMULARIO DE INSCRIPCIÓN DE VOTANTE EN ARIZONA
LAS INSTRUCCIONES EN ESPAÑOL SE ENCUENTRAN AL REVERSO
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*USE BLACK PEN ~ COMPLETELY FILL OUT FORM *USE PLUMA DE TINTA NEGRA ~ LLENE EL FORMULARIO COMPLETAMENTE
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Questions For questions regarding voter registration, call your County Recorder
listed on the back of the form
You Can Use This Form To:
Register to vote in the state of Arizona
Let us know that your name, address or party affiliation has changed
To Register To Vote In Arizona You Must (Qualifications):
Be a United States citizen (see citizenship requirements on back)
Be a resident of Arizona and the county listed on your registration
Be 18 years of age or more on or before the day of the next regular General Election
WARNING: Executing a false registration is a class 6 felony
You Cannot Register To Vote In Arizona If:
You have been convicted of a felony and have not yet had your civil rights restored
You have been adjudicated incompetent
How To Register To Vote:
To be eligible for an election, you must register to vote at least 29 days before the
election
You can mail or hand deliver your completed form to your County Recorder’s office
If by mail, the form must be received by the County Recorder no later than 5 days after
the last day to register to vote in that election or be postmarked 29 days or more before
an election and received by the County Recorder by 7 p.m. on election day
Your County Recorder’s office will mail you a proof of registration within 4 – 6 weeks
You can register online at www.azsos.gov
Citizens With Disabilities May:
Contact the County Recorder/Elections Department for information about early voting,
accessible voting, or other accommodations.
PROOF OF CITIZENSHIP REQUIREMENT
A complete voter registration form must contain
proof of citizenship or the form will be rejected. If
you have an Arizona driver license or nonoperat-
ing identification license issued after October 1,
1996, this will serve as proof of citizenship. If not,
you must enclose proof of citizenship with the
form. Please refer to the back of the form for a list
of acceptable documents to establish your citi-
zenship.
PERMANENT EARLY VOTING LIST
EARLY BALLOT – VOTE BY MAIL
Any voter may request to be included on the
“Permanent Early Voting List” (PEVL) in order to
automatically receive an early ballot for all elec-
tions he or she is eligible to participate. To be on
the list, the address where you receive mail
must be in Arizona. Military and overseas voters
are also eligible to be on the PEVL using their
overseas mailing address. To automatically
receive an early ballot, mark “Yes” in box 1.
If "Yes" is marked in box 1, you will be added to the
PEVL. If "no" is marked in box 1, your name will not
be added to the PEVL and will be removed from
PEVL if it was previously included on the list. If nei-
ther "Yes" or "No" are marked in box 1, your record
will remain unchanged as it relates to being on the
PEVL.
[1] Permanent Early Voting List – Early Ballot
(see instructions above)
YES,
I want to automatically receive an early ballot for each election for which I am eligible.
NO,
I DO NOT want to automatically
receive an early ballot.
I understand CHECKING THIS BOX will
remove my name from the list if it was previously included.
BOX FOR OFFICE USE ONLY
S
[2] Last Name First Name Middle Name Jr./Sr./III
[3] Address where you live – If no street address, describe residence location using mileage, cross streets, parcel #, subdivision name and lot, or landmarks.
Do not use post office box or business address. Draw a map below if located in rural area.
[4] Apt./Unit/
Space
[5] City [6] Zip [7] Address where you get your mail, if mail is not delivered to your home
[8] Last four digits of Social
Security Number
[9] AZ Driver License Number or AZ Nonoperating
License Number
[10]
Optional
Tribal Identification Number
[11]
Alien Registration Number
[12]
Birth Date (MM/DD/YYYY) [13]
State or Country of Birth [14]
Party Preference
Republican
Democratic
Other
______________
[15]
Telephone Number [16]
Occupation
[17]
If you were registered to vote in another state, list former address
including county and state
[18]
List former name (if applicable) [19]
Father’s name or
mother’s maiden name
[20]
Are you willing to work at a polling place on election day
Yes
No
[21]
E-mail address
[23] If no street address draw a map here:
[22]
Are you a citizen of the United States of America
Yes No
Will you be 18 years of age on or before election day
Yes No
VOTER DECLARATION By signing below, I swear or affirm that the above information is true, that I am a RESIDENT of
Arizona, I am NOT a convicted FELON or my civil rights are restored, and I have NOT been adjudicated INCOMPETENT.
X
_________________________________________________________________________________________________
SIGN HERE DATE
[24] If you are unable to sign the form, the form can be completed at your direction. The person who assisted you must sign here.
_________________________________________________________________________________________
SIGNATURE OF PERSON ASSISTING DATE
EW
N
S
If you checked “No” to either one of
these questions, do not submit this form.
Arizona Voter Registration Form
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