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
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Please write your county election office address be low.
___________________________________________________ ________
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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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