Tennessee Voter Registration Form

The Tennessee Voter Registration Form must be used in order to be able to vote in the State of Tennessee. You are required to fill and submit the form to the state office to be able to vote.

Extracted Text for Proper Search

Are you interested in working on 
Election Day? ☐ Yes     ☐ No 	
Mail-In Application For Voter Registration	
You can use this form to:	
		register to vote in Tennessee or to change your name and/or address.
To register to vote:	
		you must be a U.S. citizen, AND	
		you must be a resident of Tennessee, AND	
		you must be at least 18 years old on/or before the next election, AND	
		you must not have been convicted of a felony, or if you have, your voting rights must have been restored. 	
	 If you register by mail, you must vote in person the first time you vote after registering.	
MAIL OR HAND DELIVER THIS FORM TO YOUR COUNTY ELECTION COMMISSION.
  Go to: http://tnsos.org/elections/election_commissions.php
to find your County Election Commission address.
Instructions / checklist:
☐ Please PRINT with a blue or black  INK pen (not felt tip).
☐ Provide the information below, read and answer the VOTER DECLARATION, and sign by the “X”.
☐  An application for voter registration must be postmarked or hand deliver\
ed to the proper county election commission 
office at least 30 days before an election.
☐ V oter registration records are public records, open to inspection by any \
citizen of Tennessee, excluding social security
 numbers.
Names of persons selected for jury service in state court are not chosen\
 from permanent voter registration records.	
If you are qualified and the information on your form is complete, we will add your name to the county’ s 
voter rolls. We will then mail you a voter registration card.  This card will tell you where to vote.
Federal or State Government Issued Photo ID Is Required To Vote Unless Exception Applies.	
 LAST NAME       FIRST NAME               MIDDLE NAME              SUFFIX               SEX            RACE  (OPTIONAL)                        	☐ 	M  ☐ 	F	
ADDRESS WHERE YOU GET YOUR MAIL (IF DIFFERENT THAN ABOVE)     E-MAIL (OPTIONAL)
DATE OF BIRTH CITY AND STATE OF BIRTH  SOCIAL SECURITY #	                	PHONE #  
 
                        	
WARNING:  Giving false information to register to vote or attempting to r\
egister 
when not qualified is a felony punishable by not less than two (2) years nor more  than twelve (12) years imprisonment or a fine of $5,000 or both.	
(required under T.C.A. §  2-2-116 for 
purposes of identification and to 
avoid duplicate registration)	
X     Signature (or mark) of Applicant   Date
If applicant is unable to sign, provide signature of person who signed f\
or applicant.
 Signature of Person Assisting
 
Address	
Are you a citizen of the United States? ☐ Yes  ☐ No    
Will you be 18 years of age on or before election day? ☐ Yes  ☐ NoIf you answered "No" in response to either of the above, do not complete this form.
ADDRESS WHERE YOU LIVE (DO NOT GIVE A P.O. BOX)   APT. #  CITY  COUNTY  STATE  ZIP CODE
NAME AND ADDRESS ON LAST VOTER REGISTRATION
NAME      ADDRESS 
CITY     COUNTY     STATE    ZIP 
VOTER DECLARATION:  I, being duly sworn on oath (or 
affirmation) declare that the above address is my legal residence 
and that I plan to remain at such residence for an undetermined  period of time and say that to the best of my knowledge and  belief all of the statements made by me are true.
  1.  Are you a resident of the State of Tennessee?
  2.  Have you ever been convicted of a crime which 
is a felony in this state, by a court in this state,  
a court in another state, or a federal court?   Yes 
 No
____ ____
____ ____
ss-3010 (Rev. 10/11)

FOR COUNTY ELECTION COMMISSION USE ONLY	
Mail    Reg #    Approved    Effective Date     
P/A     District    Precinct     Ward   	
FROM:	 
 
 
 
 	PLACE
STAMP  HERE
The Post Office will not deliver 
without postage.	
Voter Registration Document - Please Do Not Delay
TO:
   	
COUNTY ELECTION COMMISSION	
 
 
 	
New Address (and mailing address if different) District/Ward/
Precinct Clerk
Date Additional Information	
TRANSFERRED TO  NEW ADDRESS