Maryland Voter Registration Application

In the case of wanting to register for voting in the State of Maryland, the following form has to be completed and submitted in order to become legally entitled to do so.

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    After This Form Is Filled Out, You Must Sign And Mail It To Your County Board of Elections. 
!      It Cannot Be Processed If It Is Faxed or E-mailed, Because It Requires An Original Signature. 
MARYLAND VOTER REGISTRATION APPLICATION	
TO REGISTER, YOU MUST
 
n Be a U.S. citizen; 
n  Be a Maryland resident; 
n  Be at least 16 years old*; 
n  Not be under guardianship for mental disability or if you are, you have 
not been found by a court to be unable to communicate a desire to 
vote; 
n  Not have been convicted of buying or selling votes; 
n  Not have been convicted of a felony, or if you have, you have 
completed serving a court-ordered sentence of imprisonment. 
*Y ou may register to vote if you are at least 16 years old but cannot vote 
unless you will be at least 18 years old by the next general election. 
DEADLINE INFORMATION 
n  This application must be postmarked no later than 21 
days before an election. 
n  If your application is complete and you are found to be quali�ed, a 
Voter Noti�cation Card will be mailed to you. 
n	  The submission of this form to an individual other than an o�cial, 
employee, or agent of a County Board of Elections does not assure 
that the form will be submitted or �led in a timely manner. 	
YOU CAN USE THIS FORM TO
 
n  Register to vote in federal, state, county, and municipal elections in 
Maryland. 
n  Change your name, address, or party a�liation. 
INSTRUCTIONS 
n	 If you do not have a current, valid Maryland driver’s license or MVA ID 
card, you must enter the last 4 digits of your social security number. 
The statutory authority allowing o�cials to request the last 4 digits 
of your social security number is Election Law Article, § 3-202. The 
number will only be used for registration and other administrative 
purposes. It will be kept con�dential. 
n	  Complete Items 1–11 in Voter Registration Application. Sign and date 
Item 12. If you are registered to vote in another Maryland county or 
another state, you must complete Items A–B in Last Voter Registration. 
n	  You must register with a party if you want to take part in that party’s 
primary election, caucus or convention. Check one box only. 
n	  Address and mail the application to your County Board of Elections, 
using the list on the back panel. 	
VOTER REGISTRATION APPLICATION PLEASE COMPLETE IN 	BLACK	 INK
 	
1 	Are you at least 16 years old? 	l Yes  l No 	
ARE YOU A U.S. CITIZEN? 	l Yes  l No 	If you answer NO to either question, do not complete this form. 	
2 	Check boxes that apply and complete Items 3–12.     
l New Registration      l Name Change  l Party A�liation Change      l Address Change 	
3 	
Last Name                                                                         \
                First Name   Middle  Su�x 	
4 	Gender:     l Male l Female 	5	 Month  Date   Year 	
Birth Date: 	
6a 	MARYLAND Driver’s License or MVA ID Number MANDATORY 	(If you have neither see instructions) 	
6b 	Social Security Number (last 4 digits) 	6c 	l Check here if you do not have either a current, valid Maryland 
driver’s license / MVA ID card or a Social Security Number 	
7 	
Maryland 	Street Number   Street Name   Apt. No.  City or Town   Zip Code   County 	Residence 
Address: 	
8 	Mailing Address 	(if di�erent from Item 7) 	
9 	
You must register with a political party if you want to take part in the political party’s primary election, caucus, or convention.  Check one box only. 
Party (check one): l  Democratic Party                 l  Republican Party                  l  Libertarian Party                  l  Green Party              
l  Una�liated  (independent of any party)                   l  Other – Specify __________________________________ 	
10 	CONTACT INFORMATION 
Daytime Phone:   Email (optional): 	
11 	l Check here if you need help voting. 
l Check here if you would like to be an election judge. 	
12 	
Under penalty of perjury, I hereby swear or a�rm: I am a U.S. citizen. 	n I am a Maryland resident. 	n I am at least 16 years old. 	n  I have not been convicted of buying or selling votes. 	n I have not been 
convicted of a felony, or if I have, I have completed serving a court-ordered sentence of imprisonment. The information in this application is true to the best of my knowledge, information and belief. 	
Signature (required) 	
X 	
Date 
l Check here if you reside in Baltimore City. 	
LAST VOTER REGISTRATION INFORMATION ( if applicable) 
Maryland State Board of Elections SBE 03-202-1 Rev 06/16  Internet VRA 	
A 	
Name 
on Last 
Registration: Last Name   Title (Jr., Sr., etc.)  
First Name  Middle Name   Date of Birth 	
B 	
Address  
on Last 
Registration: Street Number   Street Name  
Apt. No.  City or Town   Zip Code  State

After This Form Is Filled Out, You Must Sign And Mail It To Your County Board of Elections. 
!      It Cannot Be Processed If It Is Faxed or E-mailed, Because It Requires An Original Signature. 
MARYLAND VOTER REGISTRATION APPLICATION 	
WARNING QUESTIONS
 
Giving false information to obtain voter registration is 
perjury and punishable by a �ne of up to $1,000, or by 
imprisonment for up to 5 years, or both. 
PERSONAL RECORDS NOTICE/CONFIDENTIALITY 
This form collects personal information for voter 
registration purposes. If you are not registered to vote 
and you refuse to provide this information, you will not be 
allowed to vote in Maryland. You may update your voter 
registration at any time at your County Board of Elections. 
Except for items speci�ed as con�dential, voter registration 
records are generally available for public inspection; they 
may also be shared with jury commissioners/clerks or 
other government agencies as provided by law. The law 
prohibits use of voter registration records for commercial 
solicitation purposes. If you decline to register to vote, that 
fact will remain con�dential and will be used only for voter 
registration purposes. 
If you register to vote, the identity of the o�ce at which the 
application is submitted will remain con�dential and will be 
used only for voter registration purposes.  Visit the State Board of Elections website at www.elections. 
maryland.gov to verify your registration, �nd your polling 
place, and �nd out other important information. If you have 
any questions, call your County Board of Elections or the 
State Board of Elections at the numbers listed on the back 
of the application. 
If you register to vote, the identity of the o�ce at which the 
application is submitted will remain con�dential and will be 
used only for voter registration purposes. 	
!
 	
Large type Voter Registration 

Applications available upon 

request to your County Board 
of Elections or the State Board 
of Elections. 	
County Board of Elections
 	
Maryland State Board of Elections SBE 03-202-1 Rev 06/16 Internet VRA	
Allegany County 
Carroll County Harford County 
St. Mary’s County 
701 Kelly Road, Suite 213  300 S. Center Street, Rm. 212 133 Industry Lane 
P.O. Box 197 
Cumberland, MD 21502-2887  Westminster, MD 21157-5248 Forest Hill, MD 21050-1621 
Leonardtown, MD 20650-0197 
301-777-5931  410-386-2080 410-638-3565 
301-475-7844 ext. 1100 
Anne Arundel County  Cecil County Howard County 
Somerset County 
P.O. Box 490  200 Chesapeake Blvd. 9770 Patuxent Woods Drive, Suite 200 
P.O. Box 96 
Glen Burnie, MD 21060-0490  Suite 1900 Columbia, MD 21046 
Princess Anne, MD 21853-0096 
410-222-6600  Elkton, MD 21921-6395 410-313-5820 
410-651-0767 
Baltimore City  410-996-5310 
Kent County Talbot County 
Charles L. Benton Bldg.  Charles County 135 Dixon Drive 
P.O. Box 353 
417 E. Fayette Street, Rm. 129  P.O. Box 908 Chestertown, MD 21620-1141 
Easton, MD 21601-0353 
Baltimore, MD 21202-3432  La Plata, MD 20646-0908 410-778-0038 
410-770-8099 
410-396-5550 
Baltimore County  301-934-8972 
301-870-3167 
Montgomery County 
P.O. Box 4333 Washington County 
35 W. Washington Street 
P.O. Box 798  Dorchester County Rockville, MD 20849-4333 Room 101 
Cockeysville, MD 21030-0798  501 Court Lane, Rm. 105 240-777-VOTE (8683) Hagerstown, MD 21740-4833 
410-887-5700  P.O. Box 414 TDD 800-735-2258 240-313-2050 
Calvert County 
P.O. Box 798  Cambridge, MD 21613-0414 
410-228-2560 
Prince George’s County 
1100 Mercantile Lane, Suite 115A Wicomico County 
P.O. Box 4091 
Prince Frederick, MD 20678-0798  Frederick County Largo, MD 20774 Salisbury, MD 21803-4091 
410-535-2214  The Bourne Building 301-341-7300 410-548-4830 
DC Line 301-855-1376 
Caroline County 
Health & Public Services Bldg.  355 Montevue Lane 
Frederick, MD 21702 
301-600-VOTE (8683) 
Queen Anne’s County 
P.O. Box 274 
Centreville, MD 21617-0274 Worcester County 
100 Belt Street 
Snow Hill, MD 21863-1300 
403 S. Seventh Street, Suite 247  Garrett County 
410-758-0832 410-632-1320 
Denton, MD 21629-1335  Public Service Center 
410-479-8145  2008 Maryland Highway, Suite 1 
Mountain Lake Park, MD 21550-6349 
301-334-6985 	
State Board of Elections  •  P.O. Box 6486  •  Annapolis, MD 21401-0486  •  www.elections.maryland.gov  •  800-222-8683  •  MD Relay Service (800) 735-2258