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State of Utah Mail-In Voter Registration Form

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State of Utah Mail-In Voter Registration Form
State of Utah Mail-In Voter Registration Form
State of Utah
Mail-in
Voter Registration Form
Effective May 12, 2009, all voters must present identification at their polling place. Absentee voters casting a ballot for the
first time in Utah must include a copy of their identification when returning their absentee ballot.
Voter Instructions
You may use this form to:
Register to vote in Utah
Change your name or address on your voter registration record
Affiliate with a party or change your party affiliation
To register to vote in Utah, you must:
Be a citizen of the United States
Have resided in Utah at least 30 days immediately before the next election
Be at least 18 years old on or before the next election
Mail-in registration instructions:
Complete all required information
If you have registered to vote with a different name or address, complete the change of information section
One of the following is required: a Driver License number, a State Identification number, or the last four digits of your Social
Security number. If you do not have a Driver License or a State Identification card, please write “None” in the space designated
for a Driver License or State Identification and fill in your Social Security number
Read the voter declaration and citizenship affidavit and sign and date below
Mail the form to your county clerk's office (addresses are on the back of this form)
Deadline for submitting this form
This form must be postmarked at least 30 days before an election or be presented in person to the county clerk at least 15 days before an election for you
to be eligible to vote in that election. If you register less than 30 days before an election, you may only vote on Election Day and not during early voting
For more information
If you need more information, contact your county clerk at the number listed on the back of this form, or the Lieutenant Governor's Office at
elections.utah.gov or 1-800-995-VOTE
Last Name
Are you a citizen of the United States Yes No
Will you be at least 18 years on or before election day Yes No
Qualifications: If you check no in response to either of these questions do not complete this form
First Name
Office use only:
Type of ID _________________________________________ Form Type: By Mail
Voting precinct ____________ Voting ID # _______________
Reason(s) for completing this form (optional)
New Registration Party Affiliation Change
Address Change Name Change
In accordance with section 20A-2-401, the penalty for willfully causing, procuring, or
allowing yourself to be registered to vote if you know you are not entitled to vote is up to
one year in jail and a fine of up
to $2,500.
NOTICE: In order to be allowed to vote you must present valid voter identification to the poll worker before voting, which must be a valid form of photo
identification that shows your name and photograph, or, (2) two different forms of identification that show your name and current address
Middle Name
Name at Birth (if different than above)
Phone Number (optional)
Date of Birth (required, month/day/year)
Place of Birth (required, state or country)
I am a person with a disability
(optional)
Yes No
Place of Naturalization (if applicable) Date
Driver License number or State Identification number State Issued
Read and Sign below
Voter Declaration: I do swear (or affirm), subject to penalty of law for false statements,
that the information contained in this form is true and that I am a citizen of the United
States and a resident of the State of Utah, residing at the above address. I will be at least
18 years old on or before the next election and I will have resided in Utah for 30 days
immediately before the next election. I am not a convicted felon currently incarcerated for
commission of a felony.
Citizenship Affidavit: I hereby swear and affirm, under penalties
for voting fraud set forth below in Utah Code Section 20A-2-401,
that I am a citizen and that to the best of my knowledge and belief
the information above is true and correct.
Signature Date (Month/day/year)
(The above signature applies to the Voter Declaration and the Citizenship Affidavit)
Political Party: (optional)
Constitution
Democratic
Libertarian
Republican
Unaffiliated (no party preference)
O
ther (please specify
) _
_____________________
If previously registered and/or changing personal information, also fill out
this section.
Address on Previous Registration
City State Zip
County Physical Address (required, principal place of residence, no P.O. Box) City
State Zip Code
Mailing Address (if different from Physical)
County
City
State
Zip Code
Last Four Digits of Social Security Number
Name on Previous Registration
State of Utah Mail-In Voter Registration Form
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