South Carolina Voter Registration Form
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Registration Number

SOUTH CAROLINA VOTER REGISTRATION
MAIL APPLICATION
Are you a citizen of the United States of America?
Yes † No †
Will you be 18 years of age on or before election day? Yes † No †

Check One:

(Check above if moving from one county to another)

If you checked ‘NO’ in response to either of these questions,
DO NOT complete this form.

NAME
SEX

Last
Male
Female

ADDRESS
WHERE YOU
LIVE

New Registration

Address or name change within the same county

First

RACE

White

Black/African
American Asian

MI

Native
Hispanic American

Street

SOCIAL SECURITY NUMBER **

Other
Specify

_

State

Zip Code

Would you like to be a poll worker?

Yes

(Physical Address)

MAILING
ADDRESS
(if different
from above)

BIRTHDATE
PREVIOUS
REGISTRATION

_

Inside City Limits
Yes
No

Apt Number

City

Suffix

No

Street or Post Office Box
City

State

Month

Day

Year

Precinct

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