William Francis Galvin
Mail-In Voter Registration Form
Secretary of the Commonwealth
How to use this form
1. Check all the boxes that apply to you.
2. Print your name: last name, first name, middle name or initial.
3. Print your former name, if applicable.
4. Print the address where you live now: number and street name or rural
route number and box number (do not provide a post office box number),
apartment number, city or town and full zip code. Use the map† at right if
you cannot otherwise identify your address.
5. Print the address where you receive all your mail, if it is different from the
address entered on #4.
6. Print your date of birth: month, day and year.
7. Federal law requires that you provide your driver’s license number to
register to vote. If you do not have a current and valid Massachusetts driver’s
license, you must provide the last four digits of your social security number.
If you have neither, you must write “none” in the b