To register to vote in Iowa,
you must:
- be a citizen of the United States.
- be resident of Iowa.
- be at least 17 1/2 years old (you must be 18 to
vote).
- not have been convicted of a felony (or have had
your rights restored).
- not currently be judged "mentally
incompetent" by a court.
- give up your right to vote in any other place.
INSTRUCTIONS:
1. Use this form to:
(A) Register to vote; or
(B) Report a change of name, address,
telephone number, or party affiliation.
2. If you print this from the web site: Fill out
all information and place into envelope and mail to:
STORY COUNTY AUDITOR
ADMINISTRATION
900 6th STREET
NEVADA, IA 50201
3. You should receive a receipt of this
application within 14 days. If you do not, contact your county
auditor. Be ready to tell when and where you filled out the form
and to whom you gave it.
ATTN:
REGISTRATION FORMS MUST BE MAILED IN. THEY CANNOT BE E-MAILED.
WE MUST HAVE A SIGNATURE!
|
|
Deadlines for registering to
vote are 10 days before a primary or general election, 11 days before
any other election. You may register after the deadline, but your
registration will not be effective until after that election.
Normally, an application must be received by the deadline in order to be
valid for the election. However, if your registration is
postmarked at least 15 days before the election, it will be accepted for
that election even if it is received after the deadline.
Registration is permanent. After you register,
you do not have to register again unless you move to a new address.
Soc. Sec. Num. (See Privacy Act
notice at the bottom of this form).
|
Date of Birth
/
/
Mo Day Yr
|
Sex
___Male
___Female
|
County where you live.
|
Full Name -
Last
First Middle
|
Address where you
live Street
Address
Apt, Lot,
etc.
City, State, Zip
|
Address where you
get Street
Address
Apt, Lot,
etc.
City, State, Zip
your mail (if different
from above) |
Name of your School
District
|
Party Affiliation
___Democratic
___Republican
___Ia Green
___None |
Telephone number with
area code.
( )
|
Read the following and sign below:
I swear or affirm that:
*I am the person named
above
*I am a United states citizen
*I live at the address listed
above *I am at
least 17 1/2 years old
*I have not been convicted of a felony (or have received a restoration of
rights)
*I am not currently judged mentally incompetent by a court
*I do not claim the right to vote anywhere else.
_______________________________________
______________ Signature
Date WARNING: If you sign this statement and you know it is
not true you can be convicted and fined up to $7,500 and/or jailed for
up to five years.
If you ever have been registered to vote before, complete this section:
Your name then:_________________________________________
Your address then:_______________________________________
City, State, Zip Code:_____________________________________
Name of the County:______________________________________
Privacy Act Notice: Disclosure of your social security
number on this voter registration application is voluntary. It is
requested by authority of Iowa Code Section 48A.11. Failure to
provide the number will have no effect on your right to register or your
right to vote. If you provide your number, it will be used to help
avoid multiple registrations for a single individual. It may also
be disclosed to those who purchase lists of registered voters and to
those who view original voter registration records, which are public
records under Iowa Law.
|