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Florida Voter Registration Application

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Florida Voter Registration Application
Florida Voter Registration Application
Florida Voter Registration Application
Part 1 Instructions (DS-DE 39, R1S-2.040, F.A.C.)(eff. 10/2013)
Información en español: Sirvase llamar a la oficina del supervisor de
elecciones de su condado si le interesa obtener este formulario en español.
To Register in Florida, you must be:
a U.S. citizen,
a Florida resident,
at least 18 years old (you may pre-register at 16 or 17,
but cannot vote until you are 18).
If you have been convicted of a felony, or if a court has
found you to be mentally i
ncapacitated as to your right to
vote, you cannot register until your right to vote is restored.
If you do not meet any ONE of these requirements, you
are not eligible to register.
Questions
Contact the Supervisor of Elections in your county:
http://election.dos.state.fl.us/SOE/supervisor_elections.shtml
Visit the Florida Division of Elections’ website at:
http://election.dos.state.fl.us.
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
office, center for independent living, office serving persons with disabilities, public library, or armed forces recruitment
office) or the Division of Elections. Mailing addresses are on page 2 of this form.
Deadline to Register: The deadline to register to vote is 29 days before any election. You can update your
registration record at any time, but for a Primary Election, party changes must be completed 29 days before that
election. You will be contacted if your new application is incomplete, denied or a duplicate of an existing registration.
Your Voter Information Card will be mailed to you once you are registered.
Identification (ID) Requirements: New applicants must provide a current and valid Florida driver’s license number
(FL DL#) or Florida identification card number (FL ID#). If you do not have a FL DL# or FL ID#, then you must provide
the last four digits of your Social Security number (SSN). If you do not have any of these numbers, check “None.” If
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
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,
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).
The special ID is not required if you are 65 or older, have a temporary or permanent physical disability, are a member
of the active uniformed services or merchant marine who is absent from the county for active duty, or a spouse or
dependent thereof, or are currently living outside the U.S. but otherwise eligible to vote in Florida.
Political Party Affiliation: Florida is a closed primary election state. In primary elections, registered voters can only
vote for their registered party’s candidates in a partisan race on the ballot. In a primary election, all registered voters,
regardless of party affiliation, can vote on any issue, nonpartisan race, and race where a candidate faces no
opposition in the General Election. If you do not indicate your party affiliation, you will be registered with no party
affiliation. For a list of political parties, visit the Division of Elections’ website at: http://election.dos.state.fl.us/
Race/Ethnicity: It is optional to list your race or ethnicity.
Boxes: Please check boxes () where applicable.
CRIMINAL OFFENSE: It is a 3rd degree felony to submit
false information. Maximum penalties are $5,000 and/or 5
years in prison.
PUBLIC RECORD: Once filed, all information including your
phone number and email address as provided become
public record except
for the following which can only be
used for voter registration purposes: your FL DL#, FL ID#,
SSN, where you registered to vote, and whether you
declined to register or to update your voter registration
record at a voter registration agency. Your signature can be
viewed but not copied. (Section 97.0585, Fla. Stat.)
Numbered rows 1 through 7 and 12 must be completed for a new registration.
Florida Voter Registration Application
Part 2 Form (DS-DE #39, R1S-2.040, F.A.C.)(eff. 10/2013)
The downloadable/printable online form is available at:
http://election.dos.state.fl.us/pdf/webappform.pdf
This is:
New Registration
Record Update/Change (e.g., Address, Party Affiliation, Name, Signature)
Request to Replace Voter Information Card
1
Are you a citizen of the United States of America
YES
NO
OFFICIAL USE ONLY
FVRS No:
2
I affirm that I am not a convicted felon, or if I am, my right to vote has been restored.
3
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.
4
Date of Birth (MM-DD-YYYY)
- -
5
Florida Driver License (FL DL) or Florida identification (FL ID) Card Number
If no FL
DL or FL
ID, then
provide
Last 4 digits of Social
Security Number
I have
NONE of
these
numbers
.
-
-
-
-
6
Last Name
First Name Middle Name Name Suffix
(Jr., Sr., I, II, etc.):
7
Address Where You Live (legal residence-no P.O. Box) Apt/Lot/Unit City County Zip Code
8
Mailing Address (if different from above address) Apt/Lot/Unit City State or Country Zip Code
9
Address Where You Were Last Registered to Vote Apt/Lot/Unit City State Zip Code
10
Former Name (if name is changed) Gender
M
F
State or Country of Birth Telephone No. (optional)
( )
11
Email me SAMPLE BALLOTS if option is available in my county.
(See Public Record Notice above)
My email address is: