INSTRUCTIONS FOR COMPLETING APPLICATION FOR VOTE, REGISTRATION

Please complete all of the information on the application. Print in ink or type. If you have any questions about how to fill out this application, please call the Secretary of State’s Office toll free at 1-800-252-VOTE(8683), TDD 1-800-735-2989.

I . Name-Give your full name including first, middle and last. If you have changed your name, give former name.

2. Residence Address - Include street address, city, state, and zip. If you do not have a street address, give a description of the location of where you live.

3. Mailing Address - If mail cannot be delivered to your residence, give a mailing address.

4. Gender, Social Security Number, Telephone Number, and Driver's License Number or Identification Number are optional. The social security number is solicited by authority of sec. 13.122 and will be used to maintain the accuracy of the registration records. Your voter registration application is open to the public.

5. City and County of Former Residence - If you were previously registered in another county in Texas, complete this box.

6. Agent - An agent may apply for voter registration for another person as long as that person is related to the applicant as husband, wife, father, mother, son or daughter. The agent must also be a registered voter or have submitted an application for registration. Indicate the relationship of the agent on the application. Indicate relationship next to signature.

7. Sign Your Name. If you cannot sign your name next to the X, a person may witness you making your mark. Give the nane and address of the person who witnessed your mark above the signature line. If you cannot make a mark have the witness state the applicant could not make a mark. You do not need a witness if you can sign your name.

8. Indicate by checking the appropriate box above your signature if this application is a new registration, a change of name or address, or request for replacement certificate.

GENERALVOTER REGISTRATION INFORMATION

You may register to vote at any time. You must be at least 17 years and 10 months old to register. Your voter registration will become effective 30 days after it is received or on your 18th birthday, whichever is later. YOU MUST BE A U.S. CITIZEN TO REGISTER. If you move to another county, you must re-register in the county of your new residence.