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Free Alabama Voter Registration Form - PDF Form Download

Alabama Voter Registration Form
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Download and print the form and then submit it to the state office to apply for voting in the state of Alabama.


Alabama Voter Registration Form
Text Version of the Form

 Please mail or hand-deliver your completed voter registration

application to your county Board of Registrars office.

The mailing address for each county Board of Registrars is provided
on page 3 of this document.

= Page 1 =
State of Alabama Mail-In Voter Registration Form DOJ.08.22.2007
NVRA-2
‹
‹
FOR USE BY U.S. CITIZENS ONLY ‹ FILL IN ALL BOXES ON THIS FORM PLEASE USE INK PRINT LEGIBLY
You can use this form to: To register to vote in the State of Alabama, you must:
X Register to vote in Alabama. X Be a citizen of the United States.
X Update your voter registration record, if you have X Reside in Alabama.
changed your name or address. X Be at least 18 years of age on or before election day.
Deadline for submitting application: X Not have been convicted of a disqualifying felony, or if you have
Voter registration and updating of voter records is closed been convicted, you must have had your civil rights restored.
during the ten days prior to each election in Alabama. X Not have been declared “mentally incompetent” by a court.
ID requested: You may send with this application a copy of a current and valid photo identification, government check, paycheck, or other government document that shows
your name and address. You will be required to present identification when you vote absentee or at your polling place.
Are you a citizen of the United States of America? Yes No ➨ ATTENTION! If you answer “No” to either of these
Will you be 18 years of age on or before election day? Yes No ➨ questions, do not complete this application.
c Print Your Name: Last First Middle Driver’s License
3 Number:
STATE NUMBER
d Print Maiden Name / Former Name (if reporting a change of name) ➥ IF YOU HAVE NO DRIVER’S LICENSE NUMBER ➦

Last four digits of







Social Security number:
Home Telephone Work Telephone Inside City Limits? If yes, please name the city: County where you live
( ) ( ) Yes No
i Address where you live: Print House Number and Street City State ZIP
(Do not use post office box)
Addresses Current Address where you Print House Number and Street (or PO Box) City State ZIP
receive your mail:

Old Address where you were Print House Number and Street City County State ZIP
last registered to vote:
(Do not use post office box)
j Date of Birth (month, day, year) 11 Place of Birth City County State Country

 

k Race (check one) 12 Map / Diagram 13 Did you receive assistance?
White Black If your house has no street number or name, please draw a map of If you are unable to sign your name, who helped
you fill out this application? Give name, address,
where your house is located. Please include roads and landmarks.
Asian American Indian and phone number (phone number is optional).
Hispanic Other
l Sex (check one)

Female Male

REGISTRARS USE ONLY
County Pct
City Pct Voter Declaration – Read and Sign Under Penalty of Perjury
X X X X X I am a U.S. citizen I solemnly swear or affirm to support and
DATE APPROVED X X X X X I live in the State of Alabama defend the constitution of the United States and
X X X X X I will be at least 18 years of age on or the State of Alabama and further disavow any
before election day belief or affiliation with any group which
Board member X X X X X I am not barred from voting by advocates the overthrow of the governments of
reason of a disqualifying felony the United States or the State of Alabama by
conviction unlawful means and that the information
Board member X X X X X I have not been judged “mentally contained herein is true, so help me God.
incompetent” in a court of law
Your Signature: ________________________________________ Date: _______________
Board member
If you falsely sign this statement, you can be convicted and imprisoned for up to five years.
The decision to register to vote is yours. If you decide to register to vote, the office at which you are submitting this application will
remain confidential and will be used only for voter registration purposes. If you decline to register to vote, your decision will remain
confidential and will be used only for voter registration purposes.

Beth Chapman Secretary of State Questions? Call the Elections Division at 1-800-274-8683 or 334-242-7210

= Page 2 =

To mail, put the address of your county Board of Registrars on the lines below.
Autauga County Choctaw County Dallas County Jackson County Marion County Shelby County
PO Box 680036 117 S Mulberry Ave Ste 1 PO Box 987 PO Box 548 PO Box 964 PO Box 1642
Prattville 36068-0036 Butler 36904-0132 Selma 36702-0987 Scottsboro 35768-0548 Hamilton 35570-0964 Columbiana 35051-1642
(334) 361-3713 (205) 459-2531 (334) 874-2534 (256) 574-9339 (205) 921-3625 (205) 669-3913
Baldwin County Clarke County DeKalb County (256) 574-9335 Marshall County St. Clair County
PO Box 1507 PO Box 10 111 Grand Ave SW Ste 105 Jefferson County 424 Blount Ave Ste 106A 1815 Cogswell Ave Ste B-25
Bay Minette 36507-1507 Grove Hill 36451-0010 Fort Payne 35967 716 R Arrington Jr Blvd N Guntersville 35976-1122 Pell City 35125
(251) 937-0305 (251) 275-3062 (256) 845-8598 Ste A-410 (256) 571-7740 (205) 338-3954
Barbour County Clay County Elmore County Birmingham 35203-0115 Mobile County Sumter County
PO Box 402 PO Box 446 100 E Commerce St Rm 205 (205) 325-5550 151 Government St Ste 165 PO Box 783
Clayton 36016 Ashland 36251-0446 Wetumpka 36092-2746 Lamar County Mobile 36602 Livingston 35470-0783
(334) 775-8579 (256) 354-7815 (334) 567-1150 PO Box 338 (251) 574-8586 (205) 652-7902
303 E Broad St Rm 108 Cleburne County (334) 567-1197 Vernon 35592-0338 (251) 574-8587 Talladega County
(205) 695-6348
Eufaula 36027 120 Vickery St Rm 103 Escambia County (205) 695-9197 Monroe County 400 N Norton Ave
(334) 687-1585 Hefl in 36264-1166 PO Box 557 PO Box 972 Sylacauga 35150-2010
Bibb County (256) 463-5299 Brewton 36427-0557 Lauderdale County Monroeville 36461-0972 (256) 249-1007
8 Court Square W Coffee County (251) 867-0243 PO Box 1059 (251) 743-4107 x141 (256) 249-1014
Centreville 35042 6 County Complex (251) 867-0312 Florence 35630-1059 Montgomery County PO Box 6170
(205) 926-3102 New Brockton 36351-9791 Etowah County (256) 760-5840 PO Box 1667 Talladega 35161-6170
(256) 760-5841
Blount County (334) 894-5347 800 Forrest Ave Ste 206 Lawrence County Montgomery 36102-1667 (256) 761-2131
(334) 832-1215
Gadsden 35901-3651
220 Second Ave E Rm B-5 Colbert County (256) 549-5384 14330 Court St Ste 109 (256) 761-2132
Oneonta 35121 201 N Main St Moulton 35650-1139 Morgan County Tallapoosa County
(205) 625-4182 Tuscumbia 35674-2095 Fayette County (256) 974-2460 PO Box 668 125 N Broadnax St Rm 20
Bullock County (256) 386-8535 103 First Ave NW Ste 4 (256) 974-2461 Decatur 35602-0668 Dadeville 36853-1371
217 Prairie St N Rm 101 Conecuh County Fayette 35555-2627 (256) 351-4660 (256) 825-1081
Union Springs 36089-1659 111 Court St Rm 102 (205) 932-5432 Lee County (256) 351-4663 Tuscaloosa County
(334) 738-5372 Evergreen 36401 Franklin County PO Box 1530 Perry County 2501 7th St Ste 200
Opelika 36803-1530
Butler County (251) 578-7024 PO Box 70 (334) 737-3635 PO Box 555 Tuscaloosa 35401-1801
Marion 36756-0555
Russellville 35653-0070
700 Court Sq Rm 8 Coosa County (256) 332-8849 Limestone County (334) 683-2218 (205) 349-3870 x415
Greenville 36037-2308 PO Box 218 100 Clinton St S Ste E Walker County
(334) 382-5685 Rockford 35136-0218 Geneva County Athens 35611-2665 Pickens County PO Box 1472
(334) 382-6829 (256) 377-2418 PO Box 430 (256) 233-6405 PO Box 173 Jasper 35502-1472
Calhoun County Covington County Geneva 36340-0430 Carrollton 35447-0173 (205) 384-7279
1702 Noble St Ste 113 228 Hillcrest Dr (334) 684-5655 Lowndes County (205) 367-2074 Washington County
Anniston 36201-3889 Andalusia 36420-2570 Greene County PO Box 311 Pike County PO Box 1224
(256) 241-2930 (334) 428-2685 PO Box 224 Hayneville 36040-0311 120 W Church St Rm B2 Chatom 36518-1224
(334) 548-2389
Chambers County Crenshaw County Eutaw 35462-0224 (334) 548-2080 Troy 36081-1913 (251) 847-3255
(205) 372-2197
(334) 566-1757
18 Alabama Ave E Rm 101 PO Box 328 Macon County (334) 566-6449 Wilcox County
LaFayette 36862 Luverne 36049-0328 Hale County 101 Rosa Parks Ave Ste 100 PO Box 661
(334) 864-4313 (334) 335-6568 x252 905D Centerville St Tuskegee 36083-1735 Randolph County Camden 36726-0661
(334) 335-6568 x253 Greensboro 36744-1536 PO Box 215 (334) 682-9753
610 S Gilmer Ave (334) 624-4672 (334) 724-2617 Wedowee 36278-0215
Lanett 36863 Cullman County Madison County (256) 357-2138 Winston County
(334) 644-7781 500 2nd Ave SW Ste 112 Henry County 100 Northside Sq Rm 517 Russell County PO Box 459
101 Court Square Ste K
Cullman 35055-4135
Cherokee County (256) 775-4697 Abbeville 36310-2135 Huntsville 35801-4800 PO Box 700 Double Springs 35553-0459
260 Cedar Bluff Rd Ste 106 (256) 775-4750 (334) 585-6080 (256) 532-3510 Phenix City 36868-0700 (205) 489-3966
Centre 35960-1403 (256) 532-3519 (334) 298-1443 Secretary of State
(256) 927-5336 Dale County Houston County Marengo County (334) 448-1508 Elections Division
PO Box 6406
PO Box 1101
Chilton County Ozark 36361-1101 Dothan 36302-6406 PO Box 480715 PO Box 5616
PO Box 640 (334) 774-9038 (334) 677-4776 Linden 36748-0715 Montgomery 36103
Clanton 35046-0640 (334) 295-2249 (334) 242-7210
(205) 755-3820 (334) 295-2086 (800) 274-8683
YOUR ADDRESS: PUT
FIRST
CLASS
STAMP
HERE
MAIL TO:

BOARD OF REGISTRARS

= Page 3 =

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