Voter Registration Form - Washington Secretary of State

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  • Jun 24, 2013
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1 Instructions Washington State Voter Registration Form Register online at www.myvote.wa.gov Use this form to register to vote or 1 Personal information to update an existing registration. Print all information clearly using black or blue pen. last name first middle Mail or deliver this completed form male female to your county elections department. date of birth (mm / dd / yyyy) Addresses are on the next page. residential address (in Washington) apt # Deadline This registration will be in effect for the next election if postmarked or city ZIP delivered no later than the Monday four weeks before Election Day. mailing address (if different than residential address) If you miss this deadline, contact your county elections department. city state / ZIP Voting You will receive your ballot in the phone number (optional) email address (optional) mail. Contact your county elections department if you wish to vote 2 Qualifications in person. If you mark no to either of these questions, do not complete this form yes no I am a citizen of the United States of America. Notice yes no I will be at least 18 years old by the next election. If you knowingly provide false information on this voter registration 3 Military / overseas status form or knowingly make a false I am in the Armed Forces (includes National Guard and Reserves; and declaration about your qualifications military spouses or dependents away from home because of service). for voter registration you will have committed a class C felony that is I live outside the U.S. punishable by imprisonment for up 4 Identification Washington driver license / ID number to 5 years, a fine of up to $10,000, or both. Public disclosure If you do not have a Washington driver Your name, address, gender and license or ID, provide the last four xx x-x x- date of birth are public information. digits of your Social Security number 5 Former registration For more information If you are already registered and are changing your name or address, fill out this web www.vote.wa.gov section (this information will be used to update your registration) call 1-800-448-4881 visit your county elections department former last name first middle former residential address city state / ZIP 6 Declaration I declare that the facts on this voter registration form are true. I am a citizen of the United States, I will have lived at this address in Washington for at least thirty days immediately before the next election at which I vote, I will be at least 18 years old when I vote, I am not disqualified from voting due to a court order, and I am not under Department of Corrections supervision for a Washington felony conviction. sign date here here

2 Adams County King County Stevens County 210 W Broadway, Ste 200 919 SW Grady Way 215 S Oak St, Rm 106 Ritzville, WA 99169 Renton, WA 98057 Colville, WA 99114-2836 (509) 659-3249 (206) 296-8683 (509) 684-7514 Asotin County Kitsap County Thurston County PO Box 129 614 Division St, MS 31 2000 Lakeridge Dr SW Asotin, WA 99402 Port Orchard, WA 98366 Olympia, WA 98502-6090 (509) 243-2084 (360) 337-7128 (360) 786-5408 Benton County Kittitas County Wahkiakum County PO Box 470 205 W 5th Ave, Ste 105 PO Box 543 Prosser, WA 99350 Ellensburg, WA 98926-2891 Cathlamet, WA 98612 (509) 736-3085 (509) 962-7503 (360) 795-3219 Chelan County Klickitat County Walla Walla County PO Box 4760 205 S Columbus, Stop 2 PO Box 2176 Wenatchee, WA 98807 Goldendale, WA 98620 Walla Walla, WA 99362-0356 (509) 667-6808 (509) 773- 4001 (509) 524-2530 Clallam County Lewis County Whatcom County 223 E 4th St, Ste 1 PO Box 29 PO Box 398 Port Angeles, WA 98362 Chehalis, WA 98532-0029 Bellingham, WA 98227-0398 (360) 417-2221 (360) 740-1278 (360) 676-6742 Clark County Lincoln County Whitman County PO Box 8815 PO Box 28 PO Box 191 Vancouver, WA 98666-8815 Davenport, WA 99122-0028 Colfax, WA 99111 (360) 397-2345 (509) 725-4971 (509) 397-5284 Columbia County Mason County Yakima County 341 E Main St, Ste 3 PO Box 400 PO Box 12570 Dayton, WA 99328 Shelton, WA 98584 Yakima, WA 98909-2570 (509) 382- 4541 (360) 427-9670 ext 470 (509) 574-1340 Cowlitz County Okanogan County 207 4th Ave N, Rm 107 PO Box 1010 Kelso, WA 98626-4124 Okanogan, WA 98840-1010 (360) 577-3005 (509) 422-7240 Douglas County Pacific County PO Box 456 PO Box 97 Waterville, WA 98858 South Bend, WA 98586-0097 (509) 745-8527 (360) 875-9317 Ferry County Pend Oreille County 350 E Delaware Ave, Ste 2 PO Box 5015 Republic, WA 99166 Newport, WA 99156 (509) 775-5200 (509) 447-6472 Franklin County Pierce County PO Box 1451 2501 S 35th St, Ste C Pasco, WA 99301 Tacoma, WA 98409 (509) 545-3538 (253) 798-VOTE Garfield County San Juan County PO Box 278 PO Box 638 Pomeroy, WA 99347-0278 Friday Harbor, WA 98250-0638 (509) 843-1411 (360) 378-3357 Grant County Skagit County PO Box 37 PO Box 1306 Ephrata, WA 98823 Mount Vernon, WA 98273-1306 (509) 754-2011 ext 377 (360) 336-9305 Grays Harbor County Skamania County 100 W Broadway, Ste 2 PO Box 790 Montesano, WA 98563 Stevenson, WA 98648-0790 (360) 964-1556 (509) 427-3730 Island County Snohomish County PO Box 1410 3000 Rockefeller Ave, MS 505 Coupeville, WA 98239 Everett, WA 98201-4060 (360) 679-7366 (425) 388-3444 Jefferson County Spokane County PO Box 563 1033 W Gardner Ave Port Townsend, WA 98368-0563 Spokane, WA 99260 (360) 385-9119 (509) 477-2320 04/2013

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