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MARYLAND VOTER REGISTRATION APPLICATION
M a r y l a n d S t a t e B o a r d o f E l e c t i o n s S B E 0 3 - 2 0 2 - 1 R e v 0 9 / 0 8 I n t e r n e t V R A
TO REGISTER, YOu MuST
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Be a U.S. citizen;
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Be a Maryland resident;
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Be at least 18 years old or older by the next General Election;
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Not be under guardianship or mental disability;
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Not have been convicted o buying or selling votes;
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Not have been convicted o a elony, or i I have, I have completed servinga court-ordered sentence o imprisonment, including any term o parole orprobation or the conviction.
DEADLINE INORMATION
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This application must be postmarked no later than 21 days beore an elec-tion.
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I your application is complete and you are ound to be qualied, a VoterNotication Card will be mailed to you.
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The submission o this orm to an individual other than an ocial, em-ployee, or agent o a County Board o Elections does not assure that theorm will be submitted or led in a timely manner.
YOu CAN uSE ThIS ORM TO
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Register to vote in ederal, state, county, and municipal elections in Maryland.
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Change your name, address, or party aliation.
INSTRuCTIONS
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I you do not have a current, valid Maryland driver’s license or MVA ID card,you must enter at least the last 4 digits o your social security number. Thedisclosure o your ull social security number is voluntary. The statutoryauthority allowing ocials to request your social security number is Elec-tion Law Article, § 3-202. The number will only be used or registration andother administrative purposes. It will be kept condential.
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Complete Items 1-12 in Voter Registration Application. Sign and date Item13. I you are registered to vote in another Maryland county or anotherstate, you must complete Items A-B in Last Voter Registration.
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Address the application to your County Board o Elections, using the list onthe back panel.
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Ater This Form Is Filled Out, You Must Sign And Mail It To Your County Board o Elections. ItCannot Be Processed I It Is Faxed or E-mailed, Because It Requires An Original Signature.
VOTER REGISTRATION APPLICATION - PLEASE COMPLETE IN
BLACK
INK.
134
a
4
b
5678910111213
Will you be at least 18 yrs old or older on or by the next General Election? Yes NoAre you a U.S. citizen? Yes No
I yo answer NO to eiter qestion, do not complete tis orm.
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Check boxes that apply and complete Items 3-13.New Registration Party Aliation ChangeName Change Address ChangeLast Name Title (Jr., Sr., etc.) First Name Middle Name
MARYLAND
Driver’s License or MVA ID Number -
MANDATORY
(I you have neither, see instructions)
Check here i you do not have either a current, valid Marylanddriver’s license / MVA ID card or a Social Security number.Street Number Street Name Apt. No. City or Town Zip Code CountyMailing Address (i diferent rom Item 5):Month Date YearSex: Male FemaleDaytime Phone:Party (check one): Democrat Republican Green Libertarian Independent ConstitutionUnaliated
(decline to join a party)
Other-Speciy: _____________________________________________________________________Check here i you would like inormation on polling place assistanceor elderly, disabled, or voters unable to write or read the ballot.Check here i you would like inormation on working as an election judgeor your County Board o Elections.
Under penalty o perjury, I hereby swear or arm: I am a U.S. citizen. I am a Maryland resident. I will be at least 18 years old or older by the next General Election. I am not under guardianship or mentaldisability. I have not been convicted o buying or selling votes. I have not been convicted o a elony, or i I have, I have completed serving a court-ordered sentence o imprisonment, including any term o parole or probation or the conviction. The inormation in this application is true to the best o my knowledge, inormation, and belie.
BirthDate:
x
Signature (required) Date
DO NOT WRITE IN SPACE BELOW
REG. CODE CLERK’S INITIALSMCMONTH DAY YEAR
Check here i you reside inBaltimore City.MarylandResidenceAddress:
AB
LAST VOTER REGISTRATION INORMATION (i applicable)
Last Name Title (Jr., Sr., etc.) First Name Middle Name Date o BirthStreet Number Street Name Apt. No. City or Town State Zip Code CountyAddress on LastRegistration:Name on LastRegistration:
DISTRICTPRECINCTWARD
VOTER ID
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