Download the form, print it, fill it and submit it to the state office to be apply for voting in the State of Delaware.
Text Version of The Form
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STATE OF DELAWARE
VOTER REGISTRATION APPLICATION and ELIGIBILITY AFFIDAVIT
YES NO I am a citizen of the United States. If NO, do not continue.
I do not want to register to vote at this time.
Last Name First Name Middle Name Suffix
Date of Birth DE Drivers License or ID # Social Security Number Telephone Number Political Party Affiliation
Month Day Year (See back) (See back) (optional)
House # Street Name Apt/Lot/Unit # Development
City/Town State Zip Code County School District
Mailing Address if different than above
COMPLETE THIS SECTION IF YOU ARE REGISTERED TO VOTE ANYWHERE ELSE
Previous name/maiden name
Previous City, County, State, Zip Code
I hereby swear or affirm that I am a citizen of the United States, I am a permanent resident of the State of Delaware at the
address given above, I am or will be 18 years of age on or before Election Day and all of the information given above that
was provided by me is true and correct to best of my knowledge, I hereby authorize cancellation of any previous
Applicant’s Signature Date Completed
FOR DEPARTMENT, AGENCY, OR POLLING PLACE USE ONLY
ED RD New Transfer Name Change Party Change Other County Source Application Date
ED RD NEW TRANSFER NAME CHG PTY CHG OTHER COUNTY METHOD CONTROL #
Look on the back for information about registering to vote.
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• This form has two purposes: for use by citizens to register to vote and to update their
• You may register to vote if you are: a United States Citizen; a permanent resident of Delaware;
at least 18 years old on the date of the next General Election; not adjudged to be mentally
incompetent; or an ex-felon who meets the requirements as specified by law according to 15
Del C. Chapter 61. If you indicate that you are not a citizen or fail to answer that question, your
application will be rejected.
• If you register to vote even though you know you are not eligible, you can be fined between
$50.00 – $200.00 or imprisoned for 30 days to two years, or both.
• The office at which you submit this application will remain confidential except as provided by
• The information that you provide on this application, with the exception of your Social Security
Number, is public information.
• The fact that you have declined to register will remain confidential except as provided by law.
• We ask you to provide a valid Delaware Driver’s License number or Delaware ID Number. If
you have neither, we ask you to provide a Social Security Number.
• If you are submitting this application by mail and it is the first time you have registered in
Delaware, you must submit with this application, a copy of a current and valid photo
identification or a copy of a current utility bill, bank statement, government check, paycheck or
other government document that shows your name and address. If you do not provide required
identification documentation, you must provide it the first time you vote in a federal election.
• Disclosure of your telephone number is voluntary.
• You should receive a polling place card once your application has been accepted. You will be
notified by mail if your application is rejected. If you do not receive the card or other notification
in three-four weeks, please contact the Department of Elections for your county.
IDENTIFICATION NUMBER DISCLOSURE STATEMENT
Disclosure of your driver’s license number, ID number or your Social Security Number is requested so
that each individual who is registered to vote is identifiable in an accurate and efficient manner. If you
do not have a valid driver’s license number, ID number or a Social Security Number, you will be
assigned a nine (9) digit identifying number during the processing of your registration.
Your driver’s license number, ID number or your Social Security Number are used as necessary for
administrative purposes only relating to voting, including identifying you as a registered voter, insuring
no individual is registered in more than one place, verifying addresses, verifying voting districts, and
may be used for any other lawful purpose. The registration application containing your driver’s
license number, ID number or your Social Security Number will become part of the registration
records of your county.