Mississippi Voter Registration ApplicationMississippi Voter Registration Application
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MISSISSIPPI VOTER REGISTRATION APPLICATION
IMPORTANT!

If you are not registered to vote where you now live, you can use this form to register to vote or report that your name or
address has changed.

If you have questions call your county Circuit Clerk or call the Secretary of State at 1-800-829-6786.

Complete all sections of this form, then mail or hand deliver it to your county Circuit Clerk AT LEAST 30 days before the
election in which you want to vote.

If you are qualified and the information on your form is complete, you will be mailed a voter card that tells you where to
vote.
Section I. APPLICATION TO REGISTER TO VOTE
Please select one of the following:

New Registration □

1) Are you a citizen of the United States of America?

Change of Information □
Yes □

2) Will you be 18 years of age on or before election day?
CIRCLE
Mr. Mrs.
Miss Ms.

Last Name:

No □

Yes □

No □

NOTE: If you checked “No” in response to
questions 1 or 2, do not complete this form.

First Name:

Ph