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Wyoming Voter Registration Application & Change Form




INSTRUCTIONS FOR COMPLETING & SUBMITTING VOTER REGISTRATION APPLICATION FORM YOU MAY USE THIS FORM TO: REGISTER TO VOTE IN WYOMING OR TO CHANGE YOUR REGISTRATION (NAME, ADDRESS OR PARTY)  Register at the county clerk’s office: Print out the form & sign it in front of any registry agent. OR  Register by mail: Voters who are not currently in Wyoming or who cannot go to the County Clerk's office may register by mail. Follow the instructions below to mail in your voter registration application: 1. Print out the voter registration form and fill it out in front of a notary or person authorized to administer oaths. Print clearly, using a black or blue ink pen (not felt tip). 2. Show identification to the notary or registry agent. See list of acceptable documents below: Preferred identification Second option if you don’t have valid Wyoming driver’s license Valid Wyoming driver’s license Different state’s driver’s license; ID issued by a local, state or federal agency; U.S. passport; school ID; military ID Third option: 2 of any of the following documents Certificate of US citizenship or naturalization; draft record; voter registration card from another state or county; original or certified copy of birth certificate bearing an official seal; certificate of birth abroad issued by U.S. State Department; any other form of ID issued by an official agency 3. Sign the voter registration oath on the form and have the notary or registered agent sign the form. 4. Make copies of the identification documents you showed to the notary. 5. Mail the voter registration form, along with the copies of your ID documents, to your County Clerk. Note: Sending your form to any other office will delay your voter registration. 6. Mail your form as soon as possible. Voter registration closes two weeks prior to an election. 7. Follow up with your County Clerk about any questions you may have about your registration or requests for absentee ballots. See for contact details. W Y O M ING CO UNT Y C LE RK S Albany County Clerk 425 Grand Ave, Ste 202 Laramie, WY 820707 Hot Springs County Clerk 415 Arapahoe Thermopolis, WY 82443-2783 Sheridan County Clerk 224 S Main St, Ste 17 Sheridan, WY 82801-4855 Big Horn County Clerk County Courthouse, PO Box 31 Basin, WY 82410-0031 Johnson County Clerk 76 N Main St Buffalo, WY 82834-1883 Sublette County Clerk PO Box 250 Pinedale, WY 82941-0250 Campbell County Clerk PO Box 3010 Gillette, WY 82717-3010 Laramie County Clerk PO Box 608 Cheyenne, WY 82003-0608 Sweetwater County Clerk 80 W Flaming Gorge Way, Ste 155 Green River, WY 82935 Carbon County Clerk PO Box 6 Rawlins, WY 82301-0006 Lincoln County Clerk J925 Sage Ave, Ste 101 Kemmerer, WY 83101 Teton County Clerk PO Box 1727 Jackson, WY 83001-1727 Natrona County Clerk PO Box 863 Casper, WY 82601-0863 Uinta County Clerk PO Box 810 Evanston, Wy 82930-0810 Crook County Clerk PO Box 37 Sundance, WY 82729-0037 Niobrara County Clerk PO Box 420 Lusk, WY 82225-0420 Washakie County Clerk 1001 Big Horn Ave PO Box 260 Worland, WY 82401 Fremont County Clerk 450 N 2nd St, Rm 220 Lander, Wy 82520-0090 Park County Clerk 1002 Sheridan Cody, WY 82414-3589 Weston County Clerk 1 W Main Newcastle, WY 82701-2121 Goshen County Clerk PO Box 160 Torrington, WY 82240-0160 Platte County Clerk PO Drawer 728 Wheatland, WY 82201-0728 Converse County Clerk 107 N 5th St, Ste 114 Douglas, WY 82633-2448 Wyoming Voter Registration Application & Change Form New Voter Application VR # ___________________ County # ________ District _________ Precinct _________ Split __________ School __________ House __________ Senate_________ Municipality __________ Ward ____________ Change to Current Registration Name Change 1. Name and Date of Birth Legal Last Name Legal First Name Date of Birth County Resident Since Legal Middle Name Suffix 2. Wyoming Driver’s License You must provide this number if you hold a valid Wyoming Driver’s License Valid Wyoming Driver’s License Number: Mark here only if you do not have a valid Wyoming Driver’s License and go to step 2a. 2a. Social Security Number Last four digits are required if you do not have a valid Wyoming Driver’s License Social Security Number Mark here only if you do not have a valid Wyoming Driver’s License or a Social Security Number. 3. Personal Information * Denotes optional information Gender* Male Wyoming Residence Address (No P.O. Box Numbers) Female City Address Where You Get Your Mail Mailing City Phone* Are you interested in being an Election Judge?* Yes No E-mail* Do you need assistance to vote? * Yes No 4. Political Party Choose one of the following Republican 5. Changes to Current Wyoming Voter Registration Former Wyoming Residence Street Address City Former Last Name Former First Name 5a. Withdrawal of Voter Registration from Another State Street Address City Democratic Zip State Libertarian WY County Residence address in prior State County Constitution Zip Unaffiliated State Wyoming Zip Former Middle Name Suffix State Zip 6. Registration Oath and Acknowledgement Required on all applications. I do solemnly swear (or affirm) that I am a citizen of the United States; that I am a bona fide resident of the state of Wyoming and this county; that if registered in another county or state, I hereby request that my registration be withdrawn; that I will be at least eighteen (18) years of age on or before the next election; that I am not currently adjudicated a mentally incompetent person; that I have not been convicted of a felony, or if I have been convicted of a felony, I have had my civil or voting rights restored by a competent authority; and that the voter registration information contained herein is true and accurate to my best knowledge and belief. Sign your legal name in full Proof of Identification Shown Type of Identification Subscribed and affirmed or sworn to before me by __________________________________________________________ (name of applicant) on ____________________________ (application date) Title Signature & Title of Registry Agent or person authorized to administer oaths 3/2014