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State of Iowa Official Voter Registration Form

In order to qualify for voting in the State of Iowa, you have to fill and submit the Official Voter Registration form.

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STATE OF  	IOWA  	OFFICIAL  	VOTER 	REGISTRATION  	FORM	 	
In Iowa,  you  are  not  qualified  to  vote  if  you  have  been  convicted  of  a felony  and  have  not  received  a  
restoration  of  voting  rights.  You  may  apply  to  the  Governor  to  restore  your  voting  rights.  
1. Are you  a  citizen  of  the  United  States? Yes  No 
2. Will you  be  18  years  of  age  on  or  before  Election  Day? Yes   No
If  you  answered  “No”  to either  of  these  questions,  do  not  complete  this  form.	
 	
IA  driver’s  license  #:   	
 	
IA  non ‐operator  ID  #:  
Last  4  digits  of  Social  Security  number:     XXX  –  XX  –   
I  do  not  have  an  IA  driver’s  license,  non ‐operator  ID,  or  Social  Security  number.  	
 	    /        /
Female   Date of Birth (month, day, year)    
Sex        
Male  
Phone and/or Email  (optional)	
Last
  First  
Middle Suffix	
 	
Street Address	 
 	
(include  apt.,  lot,  etc.)	 
 	City   Zip  County 
If  homeless  or  you  do  not  have  an  established  residence, describe  where  you  reside:  	
  	Address/P.O.  Box	 	
City   State  Zip 
Your  name  was  
Your  address  was  
Your  city  and  state  were Your zip was  
I  swear  or  affirm  under  penal t

y of  perjury  that: 
 I am  the  person  named  above.
 I am  a  citizen  of the  United  States.
 I have  not  been  convicted  of  a  felony  (or  I  have  received  a  restoration  of rights).
 I am  at  least 17  ½  years  old.
 I live  at  the  address  listed  above.
 I am  not  currently  judged  by  a  court  to  be  “incompetent  to  vote.”
 I do  not  claim  the  right  to  vote anywhere  else.
Signature Date  Revised 4/7/2016
 	
Qualifications
ID  Number  
Provide your  Iowa  
driver’s  license,  non ‐
operator  ID number,  
or  the  last  4  digits  of  
your  Social  Security 
number  if  you  have  
one.  
Your  Name  
Address  
Where  You  
Live  
Where  You  
Receive  Mail  
(if different)  
Previous 
Voter  
Registration  
Information  
Political  
Affiliation  
(check only  one)  
Additional   Information
Date of birth and 
sex are required.
 	
WARNING 
If  you  sign  this  
form  and  you  
know  the 
information  is  
not  true,  you  
may  be  
convicted  of 
perjury  and  
fined  up  to  
$7,500  and/or 
jailed  for  up  to 
5  years.  	Registrant  Affidavit	
Republican	 	Political Parties:    
  	Democratic  	
Non‐Party Political Organizations:  	Green  
Libertarian  No Party
 
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