Free Hawaii Voter Registration Form - PDF Template

Download the form, print it, fill it and submit it to the state office to be apply for voting in the State of Hawaii.

Text Version of the Form

VOTING IN HAWAII
Voting is an essential part of our democratic process. By voting, you choose the representatives who will make
decisions affecting you, your family and your community. If you care about the future of Hawaii. . . .
register and VOTE!!
What Types of Elections Does Hawaii Hold? Will I Be Notified of My Polling Place?
In every even numbered year, Hawaii holds a Primary Election Yes . Your City/County Clerk will send you a Notice of Voter
in September and a General Election in November. Registration and Address Confirmation (NVRAC) card
with your polling place listed on it.
Who May Register to Vote?
You are not properly registered if:
You may register to vote if you are: you do not receive the NVRAC card;
a citizen of the United States of America; you no longer live at the address listed on the
a legal resident of Hawaii; and NVRAC card; or
at least 16 years of age (Pre-registration is allowed at your residence address on the NVRAC is the address of a
age 16. You must be 18 years old by election day to vote). mailing service or a business.
You are not eligible to register or to vote if you are a Do I Need an I.D. to Vote on Election Day?
convicted and confined felon or you are declared mentally
incompetent. Yes . Be sure to have an I.D. with a picture and signature
(such as a Hawaii driver’s license or state I.D. card) when
Should I Re-register to Vote? you go to vote. The NVRAC card is not an acceptable form
of identification.
You should re-register if you changed your name, residence
address or mailing address. Do I Have to Take Time Off from Work to Vote?
How Long are the Polls Open? You may be entitled to not more than two consecutive hours
off from work on election day in order to vote. Ask your
Polling places are open from 7:00 A.M. to 6:00 P.M. If you are employer first and keep your ballot stub as proof of voting
not sure of your polling place, call your City or County Clerk. (ref. HRS § 11-95).
SPECIAL VOTING SERVICES For additional information, call the Voter Hotline at:
Any voter who requires assistance to vote by reason (808) 453-VOTE (8683)
of physical, visual, or hearing disability, or an inability
to read or write may be given assistance by a person Neighbor Islands call toll-free:
of the voter’s choice — other than the voter’s employer,
agent of the employer, or agent of the voter’s union 1-800-442-VOTE (8683)
(42 U.S.C. 1973aa-6).
Website address: www.hawaii.gov/elections
Every polling place has a Voter Assistance Official
who can provide the following: Persons with hearing or speech disabilities should
language assistance materials to voters who have call the Office of Elections’ TTY phone at:
difficulty with the English language; (808) 453-6150
assistance to voters with physical disabilities; and
curbside voting services to voters who are unable Neighbor Islands call TTY toll-free:
to leave their vehicles to vote. 1-800-345-5915
or the Sprint Relay Hawaii TRS at:
711 (V/TTY); 847-9508 (FAX)
Voice Carry Over (VCO): 1 (877) 447-5992
Speech to Speech (STS): 1 (877) 447-8711
Prepared by the Office of Elections and the Association of Clerks and Election Officers of Hawaii (05/08).
———————– Page 3———————–
AFFIDAVIT ON APPLICATION FOR VOTER REGISTRATION
AFFIDAVIT NO.
STATE OF HAWAII IMPORTANT: PRINT CLEARLY
IN BLACK INK. FAILURE TO
County of Hawaii
COMPLETE ALL ITEMS WILL
County of Kauai
ss. PREVENT ACCEPTANCE OF
County of Maui } THIS APPLICATION. (FOR OFFICE USE ONLY)
City and County of Honolulu
I HEREBY SWEAR (OR AFFIRM) THAT THE FOLLOWING INFORMATION IS TRUE AND CORRECT:
SOCIAL SECURITY NUMBER* DATE OF BIRTH TELEPHONE
1 ___ ___ ___ – ___ ___ – ___ ___ ___ ___ 2 ___ ___ / ___ ___ / ___ ___ 3
Month Day Year Home: Business:
LAST NAME FIRST NAME MIDDLE INITIAL(S)
4
RESIDENCE ADDRESS IN HAWAII (Must be completed. P.O. Box, R.R., S.R. are not acceptable) CITY/TOWN ZIP CODE
5
MAILING ADDRESS IN HAWAII (Street address or P.O. Box) CITY/TOWN ZIP CODE
6
If no street/residence address, describe location of residence (leave blank if box #5 is completed) CITY/TOWN ZIP CODE
7
GENDER ARE YOU A REGISTERED VOTER IN ANOTHER STATE?
Female If “yes”, please complete the following: I was last registered to vote at:
8 9
in the county of
Male (Last Registered Address) (County) (State) (Zip Code)
and hereby authorize cancellation of my previous voter registration.
READ CAREFULLY, MARK APPROPRIATE “YES” OR “NO” BOX, AND SIGN BELOW.
I hereby swear (or afﬁ rm) that:
FOR FEDERAL, STATE, and COUNTY ELECTIONS:
a. I am a citizen of the United States of America (Non-U.S. citizens including U.S. nationals do not qualify). Yes No
10 b. I am at least 16 years of age. I understand that I must be 18 years old by election day to vote. Yes No
c. I am a resident of the State of Hawaii.
The residence stated in this afﬁ davit is not simply because of my presence in the State, but that the residence was acquired
with the intent to make Hawaii my legal residence with all the accompanying obligations therein……… Yes No
SIGNATURE
DATE
WITNESS SIGNATURE (required only if applicant makes a mark) DATE
11
ADDRESS OF WITNESS PHONE NO. OF WITNESS
ANY PERSON WHO KNOWINGLY FURNISHES FALSE INFORMATION MAY BE GUILTY OF A CLASS C
WARNINGWARNING
FELONY, PUNISHABLE BY UP TO 5 YEARS OF IMPRISONMENT AND/OR $10,000 FINE.
* Notice: Section 11-15 of the Hawaii Revised Statutes requires that a person registering to vote provide, under oath, his or her social security number, if any.
An application lacking this information will, therefore, be denied. Pursuant to Section 7 of the Federal Privacy Act (P.L. 93-579), be advised that this
information may be released to government agencies for government purposes.
For Ofﬁ ce Use Only
I.D. No. LOCATION CODE REPRESENTATIVE DISTRICT/PRECINCT
12 13 14
_____ _____ _____ _____
_____ _____ _____ _____ _____ _____
The office at which a person registers to vote is confidential. A person’s declination to register to vote is also confidential and is used for
voter registration purposes only (National Voter Registration Act of 1993). 05/08
———————– Page 4———————–
INSTRUCTIONS FOR COMPLETING THE WIKIWIKI VOTER REGISTRATION FORM
STEP 1 Complete the Affidavit on Application for Voter Registration
1. Print your Social Security Number.
2. Print your Date of Birth.
3. Print your “Home” and “Business” telephone numbers.
4. Print your Name – Last, First and Middle Initial(s).
5. Print your Residence Address in Hawaii (house number and street name). You must be registered to
vote in the county and precinct where you live.
Note: A Post Office Box, Star Route, Rural Route, General Delivery, Business Address or
Mailing Service Address is not an acceptable residence address.
6. Print your Mailing Address in Hawaii.
7. If your residence does not have a street address, describe the location of your residence. Include
details such as subdivision, village, tax map key no. and zip code.
8. Check the appropriate “Female” or “Male” box.
9. If you are registered to vote in another state but now wish to register to vote in Hawaii, complete box #9.
Your registration in that state will be canceled.
Note: You may register to vote in only one state.
10. Read carefully, mark the appropriate “Yes” or “No” box and sign on the line provided. Your application
will not be accepted if you fail to mark the appropriate boxes or withhold your signature.
11. If your signature is a mark, a witness signature is required.
Notice to First Time Voters Who Register to Vote by Mail:
If you are (1) registering to vote for the ﬁ rst time in the State of Hawaii; and (2) are mailing in this Afﬁ davit on Application
for Voter Registration, federal law (42 U.S.C. § 15483) requires you to provide proof of identiﬁ cation. Proof of identiﬁ cation
includes a copy of:
• A current and valid photo identiﬁ cation, or
• A current utility bill, bank statement, government check, paycheck or government document that shows your name and
address.
If you do not provide the required proof of identiﬁ cation with this Afﬁ davit on Application for Voter Registration, you will be
required to do so at your polling place, or with your voted absentee mail-in ballot.
STEP 2 Mail the Affidavit on Application for Voter Registration no later than 30 days prior to the
election to the appropriate City/County Clerk:
County of Hawaii City and County of Honolulu
25 Aupuni St., Rm. 105 530 S. King St., Rm. 100
Hilo, HI 96720-4245 Honolulu, HI 96813-3077
Ph. (808) 961-8277 Ph. (808) 768-3800
County of Maui County of Kauai
200 S. High St., Rm. 708 4386 Rice St.
Wailuku, HI 96793-2155 Lihue, HI 96766-1371
Ph. (808) 270-7749 Ph. (808) 241-4800