FOR OFFICIAL USE ONLY

TEXAS VOTER REGISTRATION APPLICATION

YOU’RE 3 STEPS What type of application?
<<VUID>>

 New Application  Change of Information

AWAY FROM Are you a United States Citizen?  Yes  No

BECOMING A Will you be 18 years of age on or before election day?  Yes  No

REGISTERED
LAST NAME FIRST NAME
<<lastname>> <<firstname>>

VOTER! MIDDLE NAME (if any)

<<middlename>>
FORMER NAME (if any)

RESIDENCE STREET ADDRESS CITY

If any printed information <<homeaddress>> <<city>> TEXAS
is incorrect, cross it out COUNTY ZIP
and handwrite it. <<county>> <<zip>>
MAILING ADRESS (if different)

FORMER RESIDENCE IN TEXAS (if any)

<<formeraddress>> <<formercity>> TX <<Former zip>>
DATE OF BIRTH (mm/dd/yy)
<<dob>>
Texas Driver’s License or Texas ID number: If you don’t have one, the last four digits Check if you

1 FILL OUT
of your social Security Number: have neither:
____ ____ ____ ____ ____ ____ ____ ____ XXX-XX- ____ ____ ____ ____ 
SIGNATURE OF APPLICANT: If applicant is unable to sign, write name of who helped and their relationship.
I understand that giving false information to procure a voter registration is perjury, and a crime under state and federal law. Conviction of this crime may
result in imprisonment up to 180 days, a fine up to $2,000, or both. Please read all three statements to affirm before signing.
• I am a resident of this county and a US citizen;
• I have not been finally convicted of a felony, or if a felon, I have completed all of my punishment including any term of incarceration, parole,
supervision, period of probation, or I have been pardoned; and,
• I have not been determined by a final judgment of a court exercising probate jurisdiction to be totally mentally incapacitated or partially mentally
incapacitated without the right to vote.
DATE

2 SIGN & DATE X ____ /____ /____

3 TURN OVER, REFOLD

AND PUT IN AUSTIN TX 78711-9915

RETURN ENVELOPE
PO BOX 12887
ELECTIONS DIVISION

with this address

<<COUNTY>> SECRETARY OF STATE

visible in window

<<FIRSTNAME>> <<LASTNAME>>
<<HOMEADDRESS>>
<<CITY>>, TX <<ZIP>>

Paid for by the Texas Democratic Party, TXDemocrats.org. Not authorized by any candidate or candidate’s committee.
State Democratic Executive Committee
1106 Lavaca Street, Ste 100
Austin, TX 78701
Paid for by the Texas Democratic Party,
TXDemocrats.org. Not authorized by
any candidate or candidate’s committee.

URGENT! VOTER REGISTRATION DEADLINE IS OCTOBER 9

Your voter registration application is inside.
Complete, sign and return it today!
 We noticed that there is a USPS change of address on file, but

UPDATE YOUR
your voter registration address is still your former residence.

To update your voter registration address, simply add the

VOTER
information indicated to the enclosed form, sign and date.

Stuff it back in the postage-paid envelope addressed to your

REGISTRATION
voter registrar. If any printed information is incorrect, simply
cross through it and handwrite the correct information!

Already registered at this address? Ignore this application.

If you’re unsure? Mail it in.

Mail IMMEDIATELY to be registered to vote in the November 2018 Election!

It must be RECEIVED by October 9!
Contact us at: register@txdemocrats.org with any questions.
Paid for by the Texas Democratic Party, TXDemocrats.org. Not authorized by any candidate or candidate’s committee.
 REGISTER
We noticed that you are not a registered voter at your
current address.

To register to vote today, simply add the information

TO VOTE indicated to the enclosed form, sign and date.

Stuff it back in the postage-paid envelope addressed to
your voter registrar.

TODAY Already registered at this address? Ignore this application.

If you’re unsure? Mail it in.

Mail IMMEDIATELY to be registered to vote in the November 2018 Election!

It must be RECEIVED by October 9!
Contact us at: register@txdemocrats.org with any questions.
Paid for by the Texas Democratic Party, TXDemocrats.org. Not authorized by any candidate or candidate’s committee.
 REGISTER
According to our records, you have recently become
eligible to vote in Texas. Congratulations!

To register to vote today, simply add the information

TO VOTE indicated to the enclosed form, sign and date.

Stuff it back in the postage-paid envelope addressed to
your voter registrar.

TODAY Already registered at this address? Ignore this application.

If you’re unsure? Mail it in.

Mail IMMEDIATELY to be registered to vote in the November 2018 Election!

It must be RECEIVED by October 9!
Contact us at: register@txdemocrats.org with any questions.
Paid for by the Texas Democratic Party, TXDemocrats.org. Not authorized by any candidate or candidate’s committee.