fpca

Voter Registration and Absentee Ballot Request

This form is for absent Uniformed Service members, their families, and citizens residing outside the United States. It is used to register to vote, request an absentee ballot, and update your contact information. See your state's guidelines at FVAP.gov.
Select one that applies to you:*

I am on active duty in the Uniformed Services or Merchant MarineI am an eligible spouse or dependent.I am a U.S. citizen living outside the country, and I intend to return.I am a U.S. citizen living outside the country, and my intent to return is uncertain.I am a U.S. citizen living outside the country, I have never lived in the United States.
Name*

First NameMiddle NameLast name (include suffix if applicable)
Previous names
If applicable
Birth date*

MonthDayYear
MM/DD/YYYY
Birthplace*
State or country
You need to provide at least one of the following*

Last 4 of Social Security Number.Utah Driver's license number
Social Security Number*
Last 4 of Social Security Number
Drivers license or State ID*
What is your address in Utah? Where you are registering to vote and requesting an absentee ballot. Your voting materials will not be sent to this address.
Address*
Apt or Unit number
City, town, villageStateZip CodeCounty
Where are you now? You MUST give your CURRENT address to receive your voting materials.
Your current mailing address*
Different from above address
Your mail forwarding address
If different from mailing address
How would you like to receive your voting materials?*

MailEmail or onlineFax
What is your contact information? This is so election officials can reach you about your request. Provide the country code and area code with your phone and fax number. Do not use a Defense Switched Network (DSN) number.
Email
example@example.com
Alternate email
example@example.com
Phone
Fax
What is your political party for primary elections?
What additional information must you provide?
Puerto Rico and Vermont require more information, see back for instructions. Additional state guidelines may be found at FVAP.gov.
You must read and sign this statement.

I swear or affirm, under penalty of perjury, that:
- The information on this form is true, accurate, and complete to the best of my knowledge. I understand that a material misstatement of fact in completion of this document may constitute grounds for conviction of perjury.
- I am a U.S. citizen, at least 18 years of age (or will be by the day of the election), eligible to vote in the requested jurisdiction, and I am not disqualified to vote due to having been convicted of a felony or other disqualifying offense, non have I been adjudicated mentally incompetent; or if so, my voting rights have been reinstated; and
- I am not registering, requesting a ballot, or voting in any other jurisdiction in the United States, except the jurisdiction cited in this voting form.
Sign here*

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Voter Registration and Absentee Ballot Request