1.
2.
3.
Are you a U.S. citizen?
Yes No Will you be 18 on or before the next election?
City or Township Where Your Residence is Located County unknown
Yes No
If you checked “ NO ” to either of the above questions, DO NOT complete this form.
For your convenience, this form has been designed to be filled out online, printed, signed and then mailed to the Office of the Secretary of
State. You must have Acrobat Reader 7.0 or
Local Office Use Only second page for instructions on how to fill out the form and for the mailing address. Once your form is completed online, be sure to select
"Print" at the bottom of the screen to capture your data and print the form. Sign the form and mail it to the Secretary of State's address listed below. Note: Selecting "Reset" will clear all data entry from this page. To print a blank form, go to File->Print.
Last Name or Surname Suffix
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SR
III
JR
IV
II
_____
First Name Middle Name
4.
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Address Where You Live (residence) Apt. Number
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City Zip Code
5.
6.
If Mail Cannot Be Delivered To The Address Above, Provide P.O. Box City Zip Code
Date of Birth (not today's date) Phone Number School District Where You Live
7.
8.
10a.
10b.
9.
|___|___| / |___|___| / 19
Month Day Year
|__|__|__| |__|__|__| |__|__|__|__|
(area code) (if known)
MN Driver's License Number or MN ID Card Number Federal Law requires you to provide your Minnesota Driver's
License or Minnesota Identification Card Number. -OR-
If you do not have a Minnesota Driver's License or Minnesota
Identification Card, you need to provide the last 4 digits of your
Social Security number. If you have neither, write “ NONE ” in
10b. Failure to provide this information may prevent your registration from being processed.
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Last 4 Digits of Social Security Number
|___|___|___|___|
11.
E-mail Address (optional)
If you were previously registered to vote under a different name or address, fill in numbers 12 & 13.
Previous Last Name Previous First Name Previous Middle Name
12.
|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| |__|__|__|__|__|__|__|__|__|__|__|__|__| |__|__|__|__|__|__|__|__|__|__|
Previous Address Where You Were Last Registered City State Zip Code
13.
14.
Check here if you would like information about serving as an election judge.
15.
Read The Statement Below And Sign Only If All Parts Apply To You.
I certify that I: will be at least 18 years old on election day; am a citizen of the United States; will have resided in Minnesota for 20 days immediately preceding election day; maintain residence at the address given on the registration form; am not under court-ordered guardianship in which the court order revokes my right to vote; have not been found by a court to be legally incompetent to vote; have the right to vote because, if I have been convicted of a felony, my felony sentence has expired
(been completed) or I have been discharged from my sentence; and have read and understand this statement: that giving false information is a felony punishable by not more than 5 years imprisonment or a fine of not more than $10,000, or both.
Date: |__|__| / |__|__| /
20
Month Day Year
X
Rev. 5/2006 ELECTION DAY OFFICIAL USE ONLY
W ____
P ____
SD ____
MN Driver's License or MN ID
Prior Registration
Late Notice
Tribal ID
Student ID
Passport or
Military ID
Witness
Utility Bill (type)________________________________________
ID Number: (if different from 10a)

POST
OFFICE
WILL NOT
DELIVER
WITHOUT
FIRST CLASS
POSTAGE
To register to vote in the state of Minnesota, you must meet all three of the following qualifications:
1.
A citizen of the United States of America, and
2.
A resident of Minnesota at least 20 days before election day, and
3.
At least 18 years old by election day.
Instructions to Voter
1.
Complete boxes 1 through 15 on the Minnesota Voter Registration Application.
2. Phone number is optional.
3.
Sign and date the Minnesota Voter Registration Application.
4.
Fold the application and seal. False registration is a felony persuant to Minn. Stat. 201.27
General Information
For more information on voting, registering to vote, finding your polling place, state election results, campaign information, or conducting elections, see the Minnesota Secretary of State website at www.sos.state.mn.us.
You are NOT officially registered to vote until this application is processed by your county auditor. You should receive a Voter Precinct Information Card in the mail. If you do not receive a Voter Precinct Information Card prior to the next election, or if you have further questions, please contact your county auditor.
Contact your county auditor if you need information about registration or voting assistance for people who are elderly, have disabilities, or are in health care facilities.
Deadline Information
You may pre-register to vote at any time at least 20 days before an election. If you are not able to pre-register prior to the 20 days before an election, you must register at your polling place to vote on Election Day.