You are required to complete the State of Alaska Voter Registration Application and send it by email or fax to one of the offices stated at the application forms.Download
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C03 (Rev. 02/29 /2016 ) STATE OF ALASKA VOTE R REGISTRATION APPLI CATION 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 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. Alaska House No. Street Name Apt No. City 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: 7. I am a voter with a disability and would like information on alternative voting methods. 8. I am interested in serving as an election official. (Provide your phone number and/or email address in section 12.) 9. Daytime Phone No.: Evening Phone No.: 6. *AK Voter Number: Email Address: (If known) 10. Identifiers – You MUST provide at least one: *SSN or Last 4 of SSN: / / *Alaska Driver’s License or State ID Number I have not been issued a Social Security Number, Alaska Driver’s License or State ID number. 11. You MUST provide: 12. Gender Male Female *Date of Birth / / Month Day Year 13. Political Affiliation For political affiliation choices in Alaska, see instruction number 5 on the reverse side. Write political affiliation: 14 I am registered to vote in another state, cancel my registration in: City: State: County: Zip: 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: Your signature must be a handwritten signature. A typed or digital signature is not valid. Registrar/Agency/Official – Check ID and complete this section OR Registrar Name Voter No or SSN Agency Name *Items are kept confidential by the Division of Elections and are not available for public inspection except that confidentia l addresses may be released to government agencies or during election processes as set out in state law. State of Alaska - Divis ion of Elections Voter Registration Application 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 in Alaska 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 be denied if you do not p rovide an Alaska residence address or you provide a PO Box, HC No. and Box, PSC Box, Rural Route No., Commercial Address or Mail Stop Address or a resid ence address outside of Alaska o n Line 4 of the application. If your resid ence has been assigned a stree t name and house number, provide this information or 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 ru ral 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 gener al public, but may be released to government agencies or during election processes as set out in state law. If you are temporarily out of state and have intent to return , 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. Active military and military spouses are exempt from intent requirement . Proof of Identity – Your identity must be verified. If you have been issued a Social Security number, Alaska Driver’s Licen se, or Alaska State ID card, you MUST provide at least one number on Line 10 of the application. If you have never been issued one of the identification numbers, please indicate so by checking the box on Line 10 . 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 ens ure 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 re sidency, such as a copy of your current Alaska driver's license/ID, current Alaska hunting or fishing license, student loan or college tuition documents showin g Alaska as state of residence, proof of employment in Alaska that indicates the date on which you were employed, military leave and earnings statement that identifies Alaska as the state of legal residence or other documentation that supports your claim a s an Alaska resident . If you do not provide proof of Alaska res idency, your app lication 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. Write you r political affiliation. Recognized political parties are parties who have gained recognized political party status un der Alaska Statute . Political groups are parties who have applied for recognized political party status but have not met the qualifications . Alaska political affiliations are as follows: Mail, fax or email ( as a PDF , TIFF or JPEG attachment) your completed application to one of the offices listed 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 [email protected] 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 [email protected] 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 Region III Elections Office 675 7 th Avenue Suite H3 Fairbanks, AK 99701 -4542 (907) 451 -2835 – Telephone (907) 451 -2832 – Fax Toll Free 1 -866 -959 -8683 [email protected] 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 [email protected] Native Language Assistance Toll Free 1 -866 -954 -8683 Recognized Political Parties: Alaska Democratic Party Alaska Libertarian Party Alaska Republican Party Alaskan Independence Party Political Groups: Alaska Constitution Party Green Party of Alaska Twelve Visions Party of Alaska UCES’ Clowns Party Veteran’s Party of Alaska Other: Nonpartisan (not affiliated with a political party or group) Undeclared (do not wish to declare a political affiliation)Relevant article from our knowledge database
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