State of Alaska Voter Registration ApplicationState of Alaska Voter Registration Application
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STATE OF ALASKA VOTER REGISTRATION APPLICATION

Refer to instructions on the reverse side for specific information and identification requirements.
Please print clearly in blue or black ink.
1.

You MUST complete this section for registration.
 No
I am a citizen of the United States.
 No
I am at least 18 years old or will be within 90 days of completing this application.

 Yes
 Yes

If you checked NO to either question, do not complete this form as you are not eligible to register to vote.
2.

Last Name

3.

Former Name:

4.

You MUST provide the Alaska residence address where you claim residency. Do not use PO, PSC, HC or RR.

House #

First Name

Middle Initial

Suffix

(Sr., Jr., etc.)

(If your name has changed)

Street Name

Apt #

* Keep my residence address confidential.

ALASKA

City

State

(Your mailing address in section 5 must be DIFFERENT from your residence

address in section 4 to remain confidential.)

5.

Mailing Address:

10.

 I am a voter with a disability and