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.
You MUST complete this section for registration.
I am a citizen of the United States.
I am at least 18 years old or will be within 90 days of completing this application.
If you checked NO to either question, do not complete this form as you are not eligible to register to vote.
You MUST provide the Alaska residence address where you claim residency. Do not use PO, PSC, HC or RR.
(Sr., Jr., etc.)
(If your name has changed)
* Keep my residence address confidential.
(Your mailing address in section 5 must be DIFFERENT from your residence
address in section 4 to remain confidential.)
I am a voter with a disability and