Free Wyoming Voter Registration Form - Wyoming

File Size: 172.2 kB
Pages: 1
File Format: PDF
State: Wyoming
Category: Secretary of State
Word Count: 396 Words, 2,634 Characters
Page Size: Letter (8 1/2" x 11")

Download Wyoming Voter Registration Form ( 172.2 kB)

Preview Wyoming Voter Registration Form
Wyoming Voter Registration Application & Change Form
New Voter Application
1. Name and Date of Birth Legal Last Name Date of Birth

Change to Current Registration

VR # ___________________ County # ________ District _________ Precinct _________ Split __________ School __________ House __________ Senate ___________ Municipality __________ Ward ____________ Legal Middle Name Suffix

Legal First Name County Resident Since

2. Wyoming Driver's License You must provide this number if you hold a valid Wyoming Driver's License Valid Wyoming Driver's License Number: Mark here only if you do not have a valid Wyoming Driver's License and go to step 2a. 2a. Social Security Number Last four digits are required if you do not have a valid Wyoming Driver's License Social Security Number Mark here only if you do not have a valid Wyoming Driver's License or a Social Security Number. 3. Personal Information * Denotes optional information Gender* Male Wyoming Residence Address (No P.O. Box Numbers) Female Address Where You Get Your Mail Political Party Phone* E-mail* Choose one of the following Republican Democratic

City Mailing City Libertarian Unaffiliated State

Zip Zip

Are you interested in being an Election Judge?* Do you need assistance to vote? *

Yes Yes

No No

4. Changes to Current Wyoming Voter Registration Former Wyoming Residence City WY County Street Address Former Former Last Name First Name 4a. Withdrawal of Voter Registration from Another State Residence address in prior State Street Address City County

State Wyoming Former Middle Name State

Zip Suffix Zip

5. Registration Oath and Acknowledgement

Required on all applications.

I do solemnly swear (or affirm) that I am a citizen of the United States; that I am a bona fide resident of the state of Wyoming and this county; that I will be at least eighteen (18) years of age on or before the next election; that I am not now registered in another county or state; that I am not currently adjudicated a mentally incompetent person; that I have not been convicted of a felony, or if I have been convicted of a felony, I have had my civil or voting rights restored by a competent authority; and that the voter registration information contained herein is true and accurate to my best knowledge and belief.
Sign your legal name in full Proof of Identification Shown

Type of Identification

Subscribed and affirmed or sworn to before me by
__________________________________________________________ (name of applicant) on ____________________________ (application date) Signature of Registry Agent or person authorized to administer oaths

R 1/2008 Ver. 2