Vermont Voter Registration
VERMONT Application for Addition to the Checklist (VT VOTER REGISTRATION FORM) 17 V.S.A. § 2145 (Please print clearly, use ballpoint pen, and bear down hard.)
I, ______________________________________________________________ apply to have my name (Last Name) (First Name) (Middle Initial) added to the checklist of the Town/City of ______________________________________.
By checking the boxes below, I swear or affirm that these are true statements: Yes No Are you a citizen of the United States? Yes No Will you be eighteen years of age or older on or before the day of election? Yes No Are you a resident of Vermont?
If you checked "No" in response to any of the three questions above, DO NOT complete this form. You are not qualified to vote in Vermont. Contact the Office of the Secretary of State, Elections Division, for more information at (800) 439-8683.
ONLY if you are registering to vote for the 1st time in Vermont, AND you are mailing this application to your town clerk individually, you must submit a photocopy of one of the following: current & valid photo identification OR bank statement, utility bill, or government document with your name and current address. (Do not submit I.D. if you have been previously registered in VT, if this form is submitted as part of a voter registration drive, or if you return this form to the clerk’s office in person.)
I was born on ________________________ at _________________________________ , ___________________________ (Date) (Town or City) (State)
Mailing Address: ___________________________________________________________ Tel. #: ___________________
My principal dwelling is located at: ___________________________________________________________________________________________________ . (E911 street address including number or exact physical location, if no E911 address)
The last address I was registered to vote under was:
I, ______________________________________________________________ apply to have my name (Last Name) (First Name) (Middle Initial) added to the checklist of the Town/City of ______________________________________.
By checking the boxes below, I swear or affirm that these are true statements: Yes No Are you a citizen of the United States? Yes No Will you be eighteen years of age or older on or before the day of election? Yes No Are you a resident of Vermont?
If you checked "No" in response to any of the three questions above, DO NOT complete this form. You are not qualified to vote in Vermont. Contact the Office of the Secretary of State, Elections Division, for more information at (800) 439-8683.
ONLY if you are registering to vote for the 1st time in Vermont, AND you are mailing this application to your town clerk individually, you must submit a photocopy of one of the following: current & valid photo identification OR bank statement, utility bill, or government document with your name and current address. (Do not submit I.D. if you have been previously registered in VT, if this form is submitted as part of a voter registration drive, or if you return this form to the clerk’s office in person.)
I was born on ________________________ at _________________________________ , ___________________________ (Date) (Town or City) (State)
Mailing Address: ___________________________________________________________ Tel. #: ___________________
My principal dwelling is located at: ___________________________________________________________________________________________________ . (E911 street address including number or exact physical location, if no E911 address)
The last address I was registered to vote under was: