West Virginia Voter Registra on Applica on
Please follow these steps to complete this form. (Please PRINT in blue or black ink.)
Box 1. Indicate if this is a new registration,
party change, or name/address change.
Box 2.* Provide your full legal name, including any suﬃx
(Jr., Sr., III, etc.).
Box 3.* Provide your date of birth (MM/DD/YYYY). You
must be at least seventeen years old to apply to
register to vote and will be eighteen on or before
the next general elec on.
Box 4.* Enter your WV driver’s license or DMV issued
non-driver’s ID number. If you do not have a WV
driver’s license or DMV-issued ID, enter the last
four digits of your social security number. If you
do not have any of these numbers, enter the
word “NONE” and an ID number will be assigned
Box 5.* Line 1
Provide your residence address
(do not enter a P.O. Box).** Include the
name of the county where you reside.
Provide your mailing address, if
diﬀerent from your residence address. Check
the box if you resi