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Office of Elections
(406) 258-4751
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Missoula County - Office of Elections

Department: Office of Elections
Missoula County Home

Office of Elections - Voter Registration Form

Polling Place Date Pct Ward School House Senate   Reg. #
                                

TO REGISTER: All items, except where noted, must be completed to register to vote.

Under Federal and/or state law, all electors must present ID when voting.

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*

*Note: If you checked 'No' in response to either of these questions, do not complete this form.

3. MONTANA DRIVER'S LICENSE #   _____________________________________
You MUST provide your driver's license number, if you have a driver's license.  If you do not have a driver's license, list the last four digits of your Social Security number on this line  __________________________.  If you have neither a driver's license or a Social Security number, provide (in person) or enclose (by mail) a copy of one of the following: any photo ID with your name; OR a current utility bill, bank statement, paycheck, government check, or other government document that shows your name and current address.

4. Email Address (Optional)  _____________________________________________

5. NAME (Please Print)

Last First Middle

6. COUNTY _______________________________ 9. TELEPHONE NUMBER _______________________
7. ADDRESS WHERE YOU LIVE* 10. Date of Birth  _____/ ______/ _________
*Precinct is determined by address where you live.

_________________________________________

_________________________________________
(Street, City, Zip OR Section, Township & Range)		                              Month      Day        Year 
11. PRINT FORMER NAME (if changed)

___________________________________________
8. MAILING ADDRESS (if different than #7 above)

_________________________________________

_________________________________________		 12. PLACE LAST REGISTERED

_________________________________________
CITY                      COUNTY                            STATE

13. VOTER DECLARATION (read and sign below)

I swear/affirm that: a) I am a U.S. citizen; b) I will be at least 18 years old on or before the next election; c) I will have lived in this county for at least 30 days before the next election (unless I am exempt under 13-2-514(2), MCA); d) I am neither in a penal institution for a felony conviction nor found of unsound mind by a court; e) If I don not now meet these qualifications, I will by next election; and f) I have provided true information, to the best of my knowledge under penalty of perjury. If I have given false information, I may be subject to a fine or imprisonment or both under Federal or State laws.

14.  SIGNATURE ____________________________________  DATE _________________________________