STATE OF DELAWARE
VOTER REGISTRATION APPLICATION and ELIGIBILITY AFFIDAVIT
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.
Date of Birth
DE Drivers License or ID #
Social Security Number
Political Party Affiliation
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 tha