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    State of Utah Mail-In Voter Registration Form

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    klumer_x
    This document contains instructions for registering to vote by mail in Utah. It provides information on eligibility requirements, identification needed to vote, how to complete and submit the form, deadlines, and contact information for county clerks. The form requests name, address, date of birth, driver's license or last four digits of SSN, party affiliation, and signature to register or update voter registration.

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    State of Utah Mail-In Voter Registration Form

    Uploaded by

    klumer_x
    30 views2 pages
    This document contains instructions for registering to vote by mail in Utah. It provides information on eligibility requirements, identification needed to vote, how to complete and submit the form, deadlines, and contact information for county clerks. The form requests name, address, date of birth, driver's license or last four digits of SSN, party affiliation, and signature to register or update voter registration.

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    Voter Registration Form

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    This document contains instructions for registering to vote by mail in Utah. It provides information on eligibility requirements, identification needed to vote, how to complete and submit the form, deadlines, and contact information for county clerks. The form requests name, address, date of birth, driver's license or last four digits of SSN, party affiliation, and signature to register or update voter registration.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    30 views2 pages

    State of Utah Mail-In Voter Registration Form

    Uploaded by

    klumer_x
    This document contains instructions for registering to vote by mail in Utah. It provides information on eligibility requirements, identification needed to vote, how to complete and submit the form, deadlines, and contact information for county clerks. The form requests name, address, date of birth, driver's license or last four digits of SSN, party affiliation, and signature to register or update voter registration.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    State of Utah Mail-in Voter Registration Form

    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

    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.

    Mail-in registration instructions: Complete all required information; if not applicable write N/A 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 Utah Driver License number, a Utah State Identification number, or the last four digits of your Social Security number. If you do not have a Utah Driver License or a Utah State Identification card, please write None in the space designated for a Utah Driver License or Utah 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: By Mail: This form must be postmarked at least 30 days before an election to be eligible to vote in that election Walk In: This form must be delivered in person to your county clerk at least 15 days before the election to be eligible to vote in that election PLEASE NOTE If you are qualified and the information on your form is complete, your county clerk will mail confirmation of your voter registration to you For more Information Contact your county clerk (see back of this form) Or the Lieutenant Governors Office at Elections.utah.gov or 1-800-995-VOTE

    Now register to vote on-line. For more information visit Vote.Utah.Gov

    In accordance with Utah code 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. Reason(s) for completing this form (optional) New Registration Party Affiliation Change Address Change Name Change 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

    Last Name
    Name at Birth (if different than above)

    First Name
    Place of Naturalization (if applicable)

    Middle Name Date


    State Zip Code

    Physical Address (required, principal place of residence, no P.O. Box)

    County

    City

    Mailing Address (if different from physical)

    County

    City

    State

    Zip Code

    Phone Number

    Date of Birth (required, month/day/year)

    Place of Birth (required, state or county)

    Last Four Digits of Social Security #

    Utah Driver License or Identification number


    Would you like to be a permanent absentee and receive your ballot by mail on an ongoing basis? (read declaration) Yes No

    Political Party: (optional) Elector country) Constitution Place of Birth Americans (required, state Republican Unaffiliated (no party preference) Yes

    Democratic

    Libertarian

    Other (please specify) ____________ No

    I am a person with a disability (optional)

    If previously registered and/or changing personal information, also fill out this section.

    Never registered in State of Utah

    Name on Previous Registration_________________ Address on Previous Registration______________________________________ City___________ State _____ Zip__________ 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. Vote By-Mail (only if requested): I am a qualified elector, residing at the address above and I am applying for an official absentee ballot to be sent to me and voted by me at each election in which am eligible to vote. Signature OFFICE USE ONLY
    Type of ID Voting Precinct Voting ID #

    Date (Month/Day/Year)
    Form Type: By Mail

    For more voter registration information Contact your county clerk at the address or telephone number below
    BEAVER County Clerk 105 East Center PO Box 392 Beaver, UT 84713 (435) 438-6463 BOX ELDER County Clerk 01 South Main St Brigham City, UT 84302 (435) 734-3391 CACHE County Clerk 179 North Main St., Ste 102 Logan, UT 84321 (435) 755-1460 CARBON County Clerk 120 East Main St. Price, UT 84501 (435) 636-3224 DAGGETT County Clerk 95 North 1st West PO Box 219 Manila, UT 84046 (435) 784-3154 DAVIS County Clerk 28 East State St. PO Box 618 Farmington, UT 84025 (801) 451-3589 DUCHESNE County Clerk 734 North Center Street First Name PO Box 270 Duchesne, UT 84021 (435) 738-1100 EMERY County Clerk 75 East Main PO Box 907 Castle Dale, UT 84513 (435) 381-5106 GARFIELD County Clerk 55 South Main PO Box 77 Panguitch, UT 84759 (435) 646-8826 GRAND County Clerk 125 East Center Moab, UT 84532 (435) 259-1321 IRON County Clerk 68 South 100 East PO Box 429 Parowan, UT 84761 (435) 477-8340 JUAB County Clerk 160 North Main St. Nephi, UT 84648 (435) 623-3410 KANE County Clerk 76 North Main Kanab, UT 84741 (435) 644-2458 MILLARD County Clerk 765 South Hwy 99, Ste. 6 Fillmore, UT 84631 (435) 743-6223 MORGAN County Clerk 48 West Young St. PO Box 886 Morgan, UT 84050 (801) 845-4011 PIUTE County Clerk 550 North Main PO Box 99 Junction, UT 84740 (435) 577-2840 RICH County Clerk 20 South Main PO Box 218 Randolph, UT 84064 (435) 793-2415 SALT LAKE County Clerk Elections Division 2001 S. State St. #S1100 Salt Lake City, UT 84190 (385) 468-7400 SAN JUAN County Clerk 117 South Main PO Box 338 Monticello, UT 84535 (435) 587-3223 SANPETE County Clerk 160 North Main PO Box 100 Manti, UT 84642 (435) 835-2131 SEVIER County Clerk 250 North Main PO Box 607 Richfield, UT 84701 (435) 893-0401 SUMMIT County Clerk 60 North Main PO Box 128 Coalville, UT 84017 (435) 336-3204 TOOELE County Clerk 47 South Main Tooele, UT 84074 (435) 843-3140 UINTAH County Clerk 147 East Main Vernal, UT 84078 (435) 781-5361 UTAH County Clerk 100 E. Center Rm. 3100 Provo, UT 84606 (801) 851-8128 WASATCH County Clerk 25 North Main Heber City, UT 84032 (435) 654-3211 WASHINGTON County Clerk 197 East Tabernacle St. St. George, UT 84770 (435) 634-5712 WAYNE County Clerk 18 South Main PO Box 189 Loa, UT 84747 (435) 836-1300 WEBER County Clerk 2380 Washington Blvd. Suite 320 Ogden, UT 84401 (801) 399-8400

    ___________________________________ ___________________________________ ___________________________________


    PLACE FIRST CLASS POSTAGE HERE

    Please write your county election office address below.

    ___________________________________________________________

    ___________________________________________________________

    ___________________________________________________________

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