Wyoming Voter Registration Form

Wyoming Voter Registration Form.pdf Download and submit the form to the state office to vote in the state of WyomingDownload

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11/2012 	
VR # ___________________   County # ________ 
District _________   Precinct _________   Split __________  
School __________  House __________   Senate_________  
Municipality __________   Ward ____________  	Wyoming Voter Registration Application & Change Form  
 	
 New	 Voter Application	 	 Chang	e to Current Registration	 	 	 	
 Name 	Change	 	 	
 
  1.  Name and Date of Birth	 	
Legal 	 	
Last Name  	
Legal 	 	
First Name  	
Legal 	 	
Middle Name  	
Suffix	 	
Date 	 	
of Birth 	
County 	 	
Resident S ince        	
 
2.  	Wyoming	 Driver’s L	icense    	 You must provide this number if you hold a valid Wyoming	 Driver’s L	icense	 	
Valid Wyoming Driver’s License Number:	 	
  Mark here only if you 	do not have	 a valid Wyoming Driver’s License and go to step 2a.	 	
 	2a.  Social Security N	umber      	Last four digits are required if you do not have a	 valid Wyoming	 Driver’s L	icense	 	
 	Social Security	 Number	 	
 	 Mark here only if you 	do not have	 a valid Wyoming Driver’s License 	or a Social Security N	umber.	   	
 
3.  Personal I	nformation	  * Denotes optional information	 	
Gender* 	   	 Male	 	
             
   	 Female 	
Wyoming Residence 	Address (No P.O. Box Numbers)	 	City	 	Zip	 	
Address Where Y	ou 	 	
Get Your Mail  	
Mailing 	 	
City 	
State	 	Zip	 	
Phone*  	Are you interested in being an Election Judge?*    	  Yes    	  No 	
E-mail*  	Do you need assistance to vote? *                         	  Yes    	  No  	
 
  4. Political Party      	 	
Choose one of the following                                           	 Republican             	 Democratic           	 Libertarian             	 Constitution            	 Unaffiliated     	
 
5.  Change	s to Current Wyoming 	Voter R	egistration  	 	
Former Wyoming 	Residence	 	
Street Address  	
City	 	WY County	 	State	 	
Wyoming 	
Zip	 	
Former 	 	
Last Name  	
Former 	 	
First Name 	
Former 	 	
Middle Name  	
Suffix	 	
 	5a.  Withdrawal of 	Voter 	Registration from A	nother S	tate     	Residence address in p	rior S	tate	 	
 	Street Address                                                                          	 	City	 	County	 	State	 	Zip	 	
 
6.  Registration Oath and A	cknowledgement 	     Required on all applications.	 	
I do solemnly swear (or affirm) that I am a citizen of the United	 States; that I am a bona fide resident of the state of Wyoming and this county; that 	
I will be at least eighteen (18) years of age on or before the next election; that I am not now registered in another county or state; that I am not 
currently adjudicated  a mentally incompetent person; that I have not been convicted of a felony, or if I have been convicted of a felony, I have had 
my civil or voting rights restored by a competent authority; and that the voter registration information contained herein is tru e and accurate to my 
best knowledge and belief.	 	 Sign your legal name 
 in full	 	 	 	
 Proof of Identification Shown	 	Type of Identification  	
Subscribed and affirmed or sworn to before me by  	 	
__________________________________________________________  (n ame of  applicant )  on  ____________________________  (application  date)	 	
 
Signature  & Title of Registry Agent or 
person authorized to administer oaths  	
  	Title