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Utah Voter Registration Form

The following document is the Utah Voter Registration form. This document is used for registering for voting in the State of Utah. You are required to fill this form and submit it to the state office in order to register.

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State of Utah 
 Mail-in Voter Registration Form 	
 	Voter Instructions  	You may use this form to:    Register to vote in Utah 
   Change your name or address on your voter registra tion record 
   Affiliate with a party or change your party affili ation 
  
To register to vote in Utah, you must: 
  Be a citizen of the United States 
   Have resided in Utah at least 30 days immediately  before the next election 
   Be at least 18 years old on or before the next ele ction 
 
Mail-in registration instructions:  
   Complete all required information; if not applicab le write “N/A” 
   If you have registered to vote with a different na me or address, complete the change of information s ection 
   One of the following is required: a Utah Driver Lic ense number, a Utah State Identification number, or  the last four digits of your 
Social Security number. If you do not have a Utah D river License or a Utah State Identification card, please write “None” in the space 
designated for a Utah Driver License or Utah State  Identification and fill in your Social Security number 
   Read the voter declaration and citizenship affidav it and sign and date below   
   Mail the form to your county clerk's office (addre sses are on the back of this form)   
  
Deadline for submitting this form: 
  By Mail: This form must be postmarked at least 30  days before an election to be eligible to vote in that election 
   Walk In: This form must be delivered in person to  your county clerk at least 15 days before the election to be eligible to vote in that election   
  
PLEASE NOTE   
If you are qualified and the information on your fo rm is complete, your county clerk will mail confirm ation of your voter registration to you 
  
For more Information  
Contact your county clerk (see back of this form)   
Or the Lieutenant Governor’s Office at   
Elections.utah.gov or 1-800-995-VOTE   	
   
       
 
  	
 	
   	
In accordance with Utah code section 20A-2-401, the  penalty for willfully causing, procuring, or allowing yourself to be registered to vote if you know y ou are not entitled to vote is up to one year in jail and a fine of up to $2,500.	 	
Are you a citizen of the United States?         Yes    No 
Will you be at least 18 years on or before election  day?      Yes    No 
Qualifications:  If you check no in response to either of these ques tions do not complete this form	
 	 	
Reason(s) for completing this form (optional)   New Registration                        Party Affiliation Change  
  Address Change                        Name Change	
 	             	 	
Middle Name 	
Name at Birth (if different than above)   
Phone Number	 	Date of Birth (required, month/day/year)	 	
Place of Birth (required, state or country) 	
Place of Naturalization (if applicable)  	   Date  	
Utah Driver License or Identification number   	
Read and Sign below 
Voter Declaration:  I do swear (or affirm), subject to penalty of law f or false statements, that the information contained  in this form is true and that I am a citizen of the United States 
and a resident of the State of Utah, residing at th e above address. I will be at least 18 years old on  or before the next election and I will have resided in Utah for 30 days immediately 
before the next election. I am not a convicted felo n currently incarcerated for commission of a felony .  
Citizenship Affidavit:  I hereby swear and affirm, under penalties for voti ng fraud set forth below in Utah Code Section 20A-2 -401, that I am a citizen and that to the best of my 
knowledge and belief the information above is true  and correct.  
Vote By-Mail  (only if requested): I am a qualified elector, resi ding at the address above and I am applying for an  official absentee ballot to be sent to me and voted by me at each 
election in which am eligible to vote. 	
      
                                                                               Signature                                                Date (Month/Day/Year) 	
Political Party: 	(optional)	  Americans Elect 	 Constitution 	 Democratic 	 Libertarian  	
Republican   Unaffiliated (no party preference)    Other (please specify) ____________ 
  
I am a person with a disability (optional)        Yes       No 
 	If previously registered and/or changing personal i nformation, also fill out this section.  Never registered in State of Utah    
         
Name on Previous Registration_________________ Addr ess on Previous Registration______________________________________ City___________ State _____ Zip____ ______ 
 	 	 	 	
County 	City 	State 	
Zip Code 	Mailing Address (if different from physical)          	 	County 
 	
City 
 	
State 
 	
Zip Code 
 	
Last Four Digits of Social Security # 
 	 	 	
Type of ID 	
Would you like to be a permanent absentee and recei ve your ballot by mail on an on-
going basis?  (read declaration)      Yes       No 
 	
Voting Precinct 	OFFICE USE ONLY	 	Voting ID #  	Form Type: By Mail 	
NOTICE: In order to be allowed to vote you  
must present valid voter identification to the 
poll worker before voting, which must be a 
valid form of photo identification that shows 
your name and photograph, or, (2) two 
different forms of identification that show  
your name and current address. 
 	
Physical Address (required, principal place of resi dence, no P.O. Box) 
 
Last Name 	First Name 	
Place of Birth (required, state or county) 
     
 	 	 
Now register to vote on-line.  For more  
information visit Vote.Utah.Gov

___________________________________	 	
 
___________________________________     
___________________________________           
       	
Please write your county election office address be low. 
    ___________________________________________________ ________	
 	
 
___________________________________________________ ________ 
  ___________________________________________________ ________ 
   	
 	PLACE 
FIRST 
CLASS 
POSTAGE 
HERE 	
First Name 	
BEAVER 	County Clerk 
105 East Center  
PO Box 392 
Beaver, UT  84713 
(435) 438-6463 
 
BOX ELDER  	
County Clerk	 
01 South Main St  
Brigham City, UT 84302  
(435) 734-3391  
CACHE  County Clerk 
179 North Main St., Ste 102 
Logan, UT 84321 
(435) 755-1460   
CARBON  County Clerk 
120 East Main St. 
Price, UT  84501 
(435) 636-3224   
DAGGETT  County Clerk 
95 North 1st West  
PO Box 219  
Manila, UT 84046 
(435) 784-3154   
DAVIS  County Clerk 
28 East State St. 
PO Box 618 
Farmington, UT 84025  
(801) 451-3589 	
DUCHESNE	 County Clerk 
734 North Center Street  
PO Box 270 
Duchesne, UT  84021 
(435) 738-1100 
 
EMERY  County Clerk 
75 East Main  
PO Box 907  
Castle Dale, UT 84513 
(435) 381-5106  
GARFIELD  County Clerk 
55 South Main 
PO Box 77 
Panguitch, UT  84759  
(435) 646-8826   
GRAND  County Clerk 
125 East Center  
Moab, UT  84532 
(435) 259-1321   
IRON  County Clerk 
68 South 100 East 
PO Box 429 
Parowan, UT 84761 
 (435) 477-8340   
JUAB  County Clerk 
160 North Main St.  
Nephi, UT  84648  
(435) 623-3410 	
 	
KANE	 County Clerk 
76 North Main  
Kanab, UT  84741 
(435) 644-2458 
 
MILLARD  County Clerk 
765 South Hwy 99, Ste. 6 
Fillmore, UT  84631  
(435) 743-6223   
MORGAN  County Clerk 
48 West Young St.  
PO Box 886 
Morgan, UT  84050 
(801) 845-4011   
PIUTE  County Clerk 
550 North Main  
PO Box 99 
Junction, UT 84740 
(435) 577-2840   
RICH  County Clerk 
20 South Main 
PO Box 218 
Randolph, UT  84064 
(435) 793-2415 
 
SALT LAKE  County Clerk 
Elections Division 
2001 S. State St. #S1100  
Salt Lake City, UT 84190  
(385) 468-7400 	
 	
SAN JUAN	 County Clerk 
117 South Main  
PO Box 338 
Monticello, UT 84535 
(435) 587-3223 
 
SANPETE  County Clerk 
160 North Main  
PO Box 100  
Manti, UT  84642 
(435) 835-2131   
SEVIER  County Clerk 
250 North Main 
PO Box 607 
Richfield, UT  84701  
(435) 893-0401   
SUMMIT  County Clerk 
60 North Main  
PO Box 128 
Coalville, UT 84017 
(435) 336-3204   
TOOELE  County Clerk 
47 South Main 
Tooele, UT  84074 
(435) 843-3140   
UINTAH  County Clerk 
147 East Main  
Vernal, UT  84078  
(435) 781-5361 	
 	
UTAH	 County Clerk 
100 E. Center Rm. 3100  
Provo, UT 84606 
(801) 851-8128 
 
WASATCH  County Clerk 
25 North Main 
Heber City, UT  84032  
(435) 654-3211   
WASHINGTON  County Clerk 
197 East Tabernacle St.  
St. George, UT 84770 
(435) 634-5712   
WAYNE  County Clerk 
18 South Main 
PO Box 189 
Loa, UT 84747 
(435) 836-1300 
 
WEBER  County Clerk 
2380 Washington Blvd.  
Suite 320  
Ogden, UT 84401 
(801) 399-8400 	
 	
For more voter registration information	 	 	Contact your county clerk at the address or telepho ne number below
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