Delaware Voter Registration FormDelaware Voter Registration Form
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STATE OF DELAWARE

VOTER REGISTRATION APPLICATION and ELIGIBILITY AFFIDAVIT
Control
Number:

F YES F NO I am a citizen of the United States. If NO, do not continue.
F I do not want to register to vote at this time.
Last Name

Date of Birth
Month
Day

House #

First Name

Year

Middle Name

DE Drivers License or ID #

Social Security Number

Telephone Number

(See back)

(See back)

(optional)

Street Name

City/Town

State

Zip Code

Suffix

Political Party Affiliation

Apt/Lot/Unit #

Development

County

School District

DE
Email
address (optional)
Mailing Address if different than above

COMPLETE THIS SECTION IF YOU ARE REGISTERED TO VOTE ANYWHERE ELSE
Previous name/maiden name

Previous Address

Previous City, County, State, Zip Code

OATH
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 tha