Alaska Voter Registration Form

Becoming registered as a voter in the State of Alaska requires the use of this form. Complete the form and submit it in order to become eligible for voting in the state.

Alaska Voter Registration Form.pdf Fill the Alaska Voter Registration form below and submit it to the board of registars.Download

Extracted Text for Proper Search

C03 (Rev. 02/01/2011)	
 	
STATE OF ALASKA VOTER REGISTRATION APPLICATION 	
Refer to instructions on the reverse side for specific information and identification requirements. 
Please print clearly in blue or black ink.	
  	 	
1. 
 	
You MUST complete this section for registration. 
 	Yes 	
 	Yes	  	
No 	
 	No	 	
I am a citizen of the United States. 
I am at least 18 years old or will be within 90 days of completing this application. 	
 	If you checked NO to either question, do not complete this form as you are not eligible to register to vote.	 	
2. 	Last Name  First Name  Middle Initial  Suffix 	(Sr., Jr., etc.)	 	
3. 	Former Name: 	(If your name has changed)	 	
4. 	You MUST provide the Alaska residence address where you claim residency. Do not use PO, PSC, HC or RR. 	
 	
House #  Street Name  Apt # 
City 	ALASKA	 	State 	
 	* Keep my residence address confidential. 	(Your mailing address in section 5 must be DIFFERENT from your residence 
address in section 4 to remain confidential.)	 	
5. 	Mailing Address: 	10.	 	 	I am a voter with a disability and would like 
information on alternative voting methods.	
 	
11.	  	I am interested in serving as an election official. 	(Provide your phone number and/or email address in section 12.)	 	
12.	 	
 	Daytime Phone No. 
Evening Phone No. 
Email Address 	
13. 	Political Affiliation For information on political 
types see reverse No. 5. 
 
Select only ONE Below 	
Political Parties: 	
 	Alaska Democratic Party 	
 	Alaska Libertarian Party  	
 	Alaska Republican Party 	
 	Alaskan Independence Party	 
or Political Groups: 	
 	Green Party of Alaska 	
 	Alaska Constitution Party 	
 	Veterans Party of Alaska	 
or Other: 	
 	Nonpartisan (no party affiliation) 	
 	Undeclared (no party declared) 	
 	_________________________________ 	 	
6. 	 
You MUST provide at least ONE  
 
*Social Security No.          
*Last 4 Digits of Social Security No. 
*Alaska Driver’s License No. 
*Alaska State ID Card No.	
 	
 	I have not been issued a Social Security, Alaska 
Driver’s License or State ID number. 	
7. 	 
You MUST provide   
*Date of Birth    Month Day  Year 	
8. *AK Voter Number 	 (If known)	 	
9. Sex 
 Male  Female 
14. 	If you are registered to vote in another state, you MUST cancel that registration by providing the following: 
City:                                      State:                              County:                               Zip Code: 	
Voter Certificate.  Read and Sign:  I certify, under penalty of perjury, that the above information I provided on this document is true 
and correct.  I am not registered to vote in another state, or I have provided information to cancel that registration.  I further certify that 
I am a resident of Alaska and I have not been convicted of a felony, or having been so convicted, have been unconditionally discharged 
from incarceration, probation and/or parole. 
WARNING:  If you provide false information on this application you can be convicted of a misdemeanor AS 15.56.050.	
 	
*SIGNATURE:        DATE:  
 
Registrar/Agency/Official – Check ID and complete this section	 	For Office Use Only 	
VN 
D/P 	 Registrar Name	  	Voter # or SSN	 	
OR 
Agency Name 
*Items are kept confidential by the Division of Elections and are not available for public inspection except that confidential addresses may 
be released to government agencies or during election processes as set out in state law.

To register to vote in Alaska you must be a U.S. Citizen, a resident of Alaska, and at least 18 years old or 
will be 18 years old within 90 days of completing this application. 
Initial registration or registration changes must be made at least 30 days prior to an election.  Once your application is 
processed, a notice will be mailed to you within 3 to 4 weeks. 
1. When Completing This Application You MUST Provide: 	
 Alaska Residence Address Where You Claim Residency – A complete physical residence address must be 
included on your application.  The residence address you provide will be used to assign your voter record to a 
voting district and precinct. Your application will not be processed if you leave the residence address blank or if 
you provide a PO Box, HC No. and Box, PSC Box, Rural Route No., Commercial Address or Mail Stop Address on 
Line 4 of the application. 
If your residence has been assigned a street number, provide that number.  If not, indicate exactly where you 
live such as, highway name and milepost number, boat harbor, pier and slip number, subdivision name with lot 
and block or trailer park name and space number.  If you live in a rural village in Alaska, you may provide the 
community name as your residence address. 
If you have a different mailing address than your residence address, you may choose to keep your residence 
address confidential.  Confidential addresses are not released to the general public, but may be released to 
government agencies or during election processes as set out in state law. 	
 	
Are you temporarily out of State?  If so, and you have intent to return (active military and military spouses 
are exempt from intent requirements), you may maintain your Alaska residence as it appears on your current 
record.  If you provide a new residence address, it must be within Alaska. 	
 	
 Proof of Identity – Your identity must be verified. If you have been issued a Social Security number, Alaska 
Driver’s License, or Alaska State ID card, you MUST provide at least one number on Line 6 of the application.  If 
you have never been issued one of the identification numbers, please indicate so by checking the box on Line 6. 
 Date of Birth – You MUST provide your date of birth. 
2. Are you submitting this application by mail, by fax, or email?  If so, and if you are not already registered to 
vote in Alaska, your identity must be verified either at the time you register or the first time you vote.  If you 
would like to ensure that your identity is verified at the time you register, submit a copy of one of the below: 
 Current and valid photo identification 
 Driver’s license  Passport 	
State identification card  Birth certificate 	Hunting and Fishing license 
3. Are you registering from outside the State of Alaska?  If so, you must provide proof of Alaska residency, 
such as a copy of your Alaska driver's license, Alaska hunting or fishing license, student loan or college tuition 
documents showing Alaska as state of residence, proof of employment in Alaska, military leave and earnings 
statement that identifies Alaska as the state of legal residence or other documentation that supports your claim as 
an Alaska resident.  If you do not provide proof of Alaska residency, your application will not be processed. 
4. Have you been convicted of a felony?  If so, you may register to vote only if you have been unconditionally 
discharged.  Provide a copy of your discharge papers with this application if available. 
5. Political Affiliation. Those parties that have gained recognized political party status under Alaska Statutes 
15.60.010(25) are listed under Political Parties.  Those groups that have applied for party status but have not 
met the qualifications to be a recognized political party under Alaska Statutes 15.60.010(25) are listed under 
Political Groups.  Under Other, nonpartisan means you are not affiliated with any recognized political party or 
group and undeclared means you do not wish to declare a political affiliation.  If you do not check a political 
affiliation, you will be registered as undeclared unless you are already registered under an affiliation.  	
 	
Mail, fax or email (as a pdf, tiff or jpg attachment) your completed application to one of the offices below:  	
Visit our website at: www.elections.alaska.gov	 	 	
Region I Elections Office 
PO Box 110018 
Juneau, AK 99811-0018 
(907) 465-3021 – 
Telephone 
(907) 465-2289 – Fax 
Toll Free 1-866-948-8683 Region II Elections Office 
Anchorage Office 
2525 Gambell Street Suite 100 
Anchorage, AK 99503-2838 
(907) 522-8683 – Telephone 
(907) 522-2341 – Fax 
Toll Free 1-866-958-8683 Region III Elections 
Office 
675 7	
th Avenue Suite H3 
Fairbanks, AK 99701-4594 
(907) 451-2835 – Telephone 
(907) 451-2832 – Fax 
Toll Free 1-866-959-8683 Region IV Elections Office 
PO Box 577 
Nome, AK 99762-0577 
(907) 443-5285 – Telephone 
(907) 443-2973 – Fax 
Toll Free 1-866-953-8683 	
 	
 Matanuska-Susitna Office 
North Fork Professional Building 
1700 E. Bogard Road, Suite B102 
Wasilla, AK 99654-6565 
(907) 373-8952 – Telephone 
(907) 373-8953 – Fax  Yup’ik Language Assistance 
Toll Free 1-866-954-8683 	
 	
State of Alaska 
Division of Elections 	
Voter Re	gistration A	pp	lication