Homepage Fill in a Valid Missouri Voter Registration Application Template
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The Missouri Voter Registration Application form serves as a vital tool for citizens wishing to participate in the electoral process. This form is essential for registering to vote in any election within the state, whether you are a first-time voter or updating your registration due to a change of address or name. To be eligible, applicants must be at least 18 years old by election day and must submit their application in a timely manner—either postmarked by the fourth Wednesday before the election or delivered in person to the election authority's office by the same deadline. The form requires various pieces of information, including personal details such as your full name, home address, and identification numbers. Notably, if you are registering by mail for the first time, you must include a copy of an accepted form of identification. Additionally, the application includes a section for those interested in serving as election judges, showcasing the community's commitment to facilitating the voting process. After submission, you can expect to receive confirmation of your registration within seven business days, ensuring that you are on the voter rolls and ready to make your voice heard on election day.

Missouri Voter Registration Application Preview

MISSOURI VOTER REGISTRATION APPLICATION

Use this application to:

1.Register to vote in any election in Missouri.

2.Register to vote when you move from one jurisdiction (St. Louis City, Kansas City, or any county) to another jurisdiction (St. Louis City, Kansas City, or any county) within Missouri.

3.Change the address on a current voter registration when you move within a jurisdiction.

4.Change the name on a current voter registration.

Other information:

1.You must be 18 years of age by the day of a particular election to be eligible to vote in that election.

2.If mailed, this form must be postmarked by the 4th Wednesday preceding an election to be eligible to vote in that election. If delivered in person, it must be received in the office of the election authority by the 4th Wednesday preceding an election. (See reverse for election calendar.)

3.Submitting this application to an individual other than the election authority does not insure timely voter registration.

4.After the election authority receives your voter registration application, you will be sent confirmation within 7 business days. If you do not receive confirmation, contact the election authority.

5.If you wish to serve as an election judge on election day please contact your local election authority and mark the box at the bottom of this form.

6.Optional—If registering by mail for the first time, please submit a copy of one of the following forms of identification: current or valid photo ID, current utility bill, bank statement, government check, paycheck or other government document that shows your name and address, birth certificate, Native American tribal document or other proof of United States citizenship. (You will be required to present identification when you vote.)

Completing this form (All information is required unless indicated as optional): Boxes 1 and 2 -- Citizen and Age Requirements

Federal Law requires voter registration applicants to answer these two questions.

Box 3 -- Type of Application

Check appropriate box if this is a new registration or if you are changing a name or address on your current voter registration.

Box 4 -- Name

Put in this box your full name (Last, First, Middle). DO NOT use nicknames or initials. For name changes, Box 12 should contain your old name.

Box 5 -- Home Address

List your home address. DO NOT put your mailing address if it differs from your home address.

Box 6 -- Mailing Address

If you get your mail at an address other than your home address in Box 5, put that address here in this box.

Box 7 -- Driver’s License Number

Required for registration unless you do not have a Driver’s License. (§115.158, RSMo.) If you do not have a Driver’s License, leave blank.

Box 8 -- Last Four Digits of Social Security Number

Required for registration unless you do not have a Social Security Number. (§115.155, RSMo, §115.158, RSMo.) If you do not have a Social Security Number, leave blank.

Box 9 -- Date of Birth

Place your date of birth in this box (Month, Day, Year). DO NOT USE TODAY’S DATE!

Box 10 -- Place of Birth (Optional)

List your place of birth (city/county/state).

Box 11 -- Daytime Phone Number (Optional)

Please list a number at which the election authority may contact you for clarification of information.

Box 12 -- Last Voter Registration Information

If you are currently registered, please list the name and address of your last regis- tration including county and state.

Box 13 -- Signature

Review the information. If you meet the requirements and all is correct, sign your full name or make your mark and print today’s date.

Box 14 -- Rural Voters

If you live in a rural area without a street address, please supply information which may help in placing you in the proper voting district.

YOUR APPLICATION WILL BE CONFIRMED BY MAIL WITHIN SEVEN (7) BUSINESS DAYS OF ITS RECEIPT BY THE ELECTION AUTHORITY. PLEASE CONTACT THE ELECTION AUTHORITY IF YOU DO NOT RECEIVE NOTIFICATION.

(DETACH HERE - KEEP TOP PORTION FOR YOUR RECORDS) This card is not proof of registration.

MISSOURI VOTER REGISTRATION APPLICATION

USE PEN - PLEASE PRINT CLEARLY

PC

1 ARE YOU A CITIZEN OF THE UNITED STATES OF AMERICA?

 

 

 

 

 

 

YES

NO

2

WILL YOU BE 18 YEARS OF AGE ON OR BEFORE ELECTION DAY?

YES

NO

 

 

 

 

 

 

 

If you checked no in response to either of the above questions, do not complete this form.

3

 

 

 

NEW REGISTRATION

ADDRESS CHANGE

 

NAME CHANGE

FOR OFFICE USE ONLY REGISTRATION NO.

 

 

 

4

LAST NAME

 

 

FIRST NAME

 

 

MIDDLE NAME

 

 

 

SUFFIX

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MALE

FEMALE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

JR.

SR. II

 

III IV

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5

ADDRESS WHERE YOU LIVE (HOUSE NO., STREET, APT. NO. OR RURAL ROUTE AND BOX - NO PO BOXES)

 

 

CITY

 

 

 

 

 

 

COUNTY

 

 

 

 

 

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6

ADDRESS WHERE YOU GET YOUR MAIL (REQUIRED IF DIFFERENT FROM #5 ABOVE)

 

 

CITY

 

 

 

 

 

 

STATE

 

 

 

 

 

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7

DRIVER’S LICENSE NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

8

LAST 4 DIGITS OF SOCIAL SECURITY NUMBER*

 

 

 

 

 

 

 

 

 

 

IF YOU DO NOT HAVE A DRIVER’S LICENSE,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IF YOU DO NOT HAVE A SOCIAL SECURITY NUMBER, PLEASE LEAVE BLANK.

 

 

 

PLEASE LEAVE BLANK.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9

DATE OF BIRTH (MM/DD/YYYY)

 

 

10

PLACE OF BIRTH (OPTIONAL)

 

 

 

 

 

11

DAYTIME PHONE NO. (OPTIONAL)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12

NAME AND ADDRESS ON LAST VOTER REGISTRATION

 

 

 

 

13

 

I hereby certify that I am a citizen of the United States and a resident of the state of

 

NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Missouri. I am at least seventeen and one half years of age. I have not been adjudged

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

incapacitated by any court of law. If I have been convicted of a felony or a

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

misdemeanor connected with the right of suffrage, I have had the voting disabilities

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY

STATE

 

 

 

 

 

 

 

resulting from such conviction removed pursuant to law. I swear under penalty of

 

 

 

 

 

 

 

 

perjury that all statements made on this card are true to the best of my knowledge

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COUNTY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and belief. I understand that if I register to vote knowing that I am not legally entitled

 

If currently registered in another state or county please complete this box.

 

 

 

 

 

 

 

to register, I am committing a class one election offense and may be punished by

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

imprisonment of not more than five years or by a fine of between two thousand five

14 RURAL VOTERS: COMPLETE THIS SECTION IF YOU LIVE OUTSIDE THE CITY LIMITS OF

 

 

 

 

 

hundred dollars and ten thousand dollars or by both such imprisonment and fine.

 

 

ANY CITY.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I live

 

 

 

 

 

 

 

miles N S

E W (circle one) of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(landmark or junction).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section,Township and range

 

 

 

 

 

 

 

 

 

 

 

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Date

 

Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

My neighbors are

 

 

 

 

 

 

 

 

 

 

 

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Check here if you are interested in working as an Election Judge

Warning: Conviction for making a false statement may result in imprisonment for up to five years and/or a fine up to $10,000.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MO 231-0169 (REVISED 04-07) *Required for registration pursuant to §115.155 RSMo and §115.158 RSMo.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dos and Don'ts

When filling out the Missouri Voter Registration Application, it is important to follow certain guidelines to ensure your application is processed smoothly. Here is a list of things you should and shouldn't do:

  • Do ensure you are a U.S. citizen and will be at least 18 years old by election day.
  • Do use your full name as it appears on official documents; avoid nicknames or initials.
  • Do provide your current home address accurately; do not use a PO Box.
  • Do check the appropriate box for your type of application (new registration, address change, name change).
  • Do sign the application and include today’s date.
  • Don't submit the application without ensuring all required fields are completed.
  • Don't use today’s date for your date of birth; provide your actual birth date instead.
  • Don't provide a mailing address if it is the same as your home address; only include it if it differs.
  • Don't forget to mail your application by the deadline or deliver it in person to the election authority.
  • Don't assume your application is processed without confirmation; follow up if you do not receive notification within seven business days.

Key takeaways

When filling out and using the Missouri Voter Registration Application form, consider the following key points:

  • Eligibility: You must be a U.S. citizen and at least 18 years old by election day to register.
  • Submission Deadlines: If mailing the application, it must be postmarked by the 4th Wednesday before the election. In-person submissions must be received by the same date.
  • Confirmation: After your application is received, expect confirmation by mail within 7 business days. If you do not receive it, contact the election authority.
  • Identification: If registering by mail for the first time, include a copy of an acceptable form of ID, such as a photo ID or utility bill showing your name and address.
  • Complete Information: Fill out all required fields accurately. This includes your full name, home address, and either your driver's license number or the last four digits of your Social Security number.
  • Name Changes: If you are changing your name, provide your old name in the designated section of the application.
  • Election Judge: If you wish to serve as an election judge, indicate this on the form and contact your local election authority for more information.
  • Rural Addresses: If you live in a rural area without a street address, provide details that will help identify your voting district.
  • False Statements: Be aware that providing false information can lead to serious legal consequences, including fines and imprisonment.

Misconceptions

Understanding the Missouri Voter Registration Application form is crucial for ensuring that you are able to vote. However, several misconceptions can lead to confusion. Here are five common misconceptions:

  • Misconception 1: You can register to vote at any time.
  • In reality, the application must be submitted by the 4th Wednesday preceding an election. If mailed, it must be postmarked by that date. If you miss this deadline, you will not be eligible to vote in that election.

  • Misconception 2: You can use any name or initials on the application.
  • The application requires your full name without nicknames or initials. This ensures that your registration matches official records, which is essential for validating your identity when you vote.

  • Misconception 3: You do not need to provide identification when registering.
  • While it is optional to submit identification when registering by mail for the first time, you will need to present valid identification when you vote. This is a critical step in ensuring the integrity of the voting process.

  • Misconception 4: You will automatically receive confirmation of your registration.
  • After your application is received, you should expect confirmation within seven business days. If you do not receive this confirmation, it is important to contact the election authority to verify your registration status.

  • Misconception 5: Changing your address does not require a new application.
  • If you move within the same jurisdiction or to a different jurisdiction, you must submit a new application. This ensures that your voter registration reflects your current address, which is necessary for you to vote in the correct district.

Similar forms

  • National Voter Registration Form: This federal form allows individuals to register to vote in any state. Like the Missouri form, it requires personal information, including name, address, and identification details. Both forms aim to ensure that voters meet eligibility requirements and provide a straightforward way to register.
  • State Driver's License Application: When applying for a driver's license, applicants must provide personal information such as their name, address, and date of birth. Similar to the voter registration application, it verifies identity and residency, helping to maintain accurate records for state services.
  • Change of Address Form: This form is used to update an individual's address with various agencies, including the postal service. Much like the voter registration application, it ensures that important correspondence reaches the correct address and keeps records current.
  • Texas Bill of Sale: This legal document facilitates the transfer of ownership for personal property in Texas. It is crucial for establishing clarity and legality in transactions, such as vehicle sales, and can be found at https://topformsonline.com/texas-bill-of-sale.
  • Federal Employment Application: When applying for a federal job, applicants must provide their personal information and confirm their eligibility to work. This process parallels the voter registration application, as both require verification of identity and eligibility.
  • School Enrollment Form: Students enrolling in a school must fill out a form that includes their personal information and proof of residency. This form serves a similar purpose as the voter registration application, ensuring that only eligible students are registered and that their information is accurate.
  • Passport Application: When applying for a passport, individuals must submit personal information and proof of citizenship. This document is similar to the voter registration application in that it verifies identity and eligibility, ensuring that only qualified individuals receive government-issued identification.
  • Health Insurance Enrollment Form: Individuals enrolling in health insurance must provide their personal details and proof of residency. Like the voter registration application, this form helps ensure that applicants meet eligibility criteria and that their information is accurately recorded.