Voter Registration Form

Voter Registration Form
Name*

First NameMiddle NameLast NameSuffix
Name at birth or previous legal name
If different from above
Residential Address *
No PO Boxes
Unit or Apt Number
CityStateZip CodeCounty
Select one*

My mailing address is the same as my residence.My mailing address is different than my residence.
Mailing Address or PO Box
Millville and Paradise require a PO Box
Unit or Apt Number
CityStateZip Code
Birthdate*

MonthDayYear
Date
Place of Birth state or country*
Choose one of the following to provide*

Utah Driver's LicenseLast 4 of Social Security Number
Last 4 of Social Security Number*
Utah Driver's License Number*
A minimum of 9 digits is required
Place of naturalization
If applicable
Date of naturalization

MonthDayYear
If applicable
I would like to be a member of the following political party

Constitution PartyDemocratic PartyGreen PartyIndependent American PartyLibertarian PartyNo Labels PartyRepublican PartyUnited Utah PartyUtah Forward PartyUnaffiliated (no party preference)Other
Check any that apply to you.

I am a voter with a disability.I would like to be a pollworker.I am a voter residing out of the US.I am an active military voter or a dependent of one.
Since you are an overseas or military voter, you may designate an email address or fax number where your ballot will be sent
To ensure we can reach you for verification purposes, please provide your email address and/or phone number. Email addresses and phone numbers are confidential and will not be shared.
Phone Number
Email address
Select one

I have previously registered to vote.I have never registered to vote.
Previous Voter Residential Address
Unit or Apt Number
CityStateZip Code
Privacy information

YES, I request that all information on my voter registration records be withheld from all persons other than government entities, political parties, candidates for public office, and their contractors, employees, and volunteers. For information about requesting additional privacy protection, and to learn about specific circumstances when a person's voter registration can be withheld from the groups listed above, please see the reverse side of this form.
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. Unless I have indicated above that I am preregistering to vote in a later election, I will be at least 18 years of age and will have resided in Utah for 30 days immediately before the 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

Clear
Todays Date

MonthDayYear
Date

Since you selected "No," you are unable to fill out this form. You must be United States Citizen in order to register to vote.

Since you selected "No," you are unable to fill out this form. You must be at least 18 to register to vote or 16 to preregister. Please come back when you are old enough.

Thank you!
Should be Empty:

Voter Registration Form

Voter Registration Form

Since you selected "No," you are unable to fill out this form. You must be United States Citizen in order to register to vote.

Since you selected "No," you are unable to fill out this form. You must be at least 18 to register to vote or 16 to preregister. Please come back when you are old enough.

Thank you!