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Answer the questions below then press the "Continue" button at the bottom of this page. You will then print the form, sign it, and either mail or deliver to Election Supervisor.



Are you a United States citizen? If NO, you cannot register to vote.
(Required)		Yes   No


I affirm I am not a convicted felon, or if I am, my rights relating to voting
have been restored?
(Required)

I affirm.


I affirm I have not been adjudicated mentally incapacitated with respect to voting or,
 if I have, my competency has been restored.
(Required)

I affirm.


Date of birth (example: 07/04/1976)
(Required)   

 /  / 
 
Florida Driver License/Florida ID Card number (Please specify as follows...)
If you have a current FL DL# or FL ID card, you must provide the number here. 
If you do not have either of the above, then you must provide the last 4 digits of your SSN. 
If you have not been issued a FL DL#, FL ID#, or SSN, please specify -- 
  "I do not have any of the above forms of ID": 
I have a Florida Driver's license or Florida ID
I only have a Social Security ID
I do not have any of the above forms of ID
Enter FL DL#/FL ID below
Enter Last 4 digits of SSN# below



Name (If you use a Suffix that is not listed, please include it in the Last Name field)
First Name
Middle Name
Last Name (required)
Suffix



Residential Address
Street Address
Apt/Lot/Unit
City
State
Zip Code




Mailing Address
(if different from above)
Street Address
Apt/Lot/Unit
City
State
Zip Code





Party Affiliation -- check one box only (see instructions)
  • If you wish to register with a major political party, click the circle preceding the listed party with which you wish to affiliate.
  • If you wish to register with a minor political party, click the circle preceding "Other Party" and print the name of the party with which you wish to affiliate.
  • If you wish to register without party affiliation, click the circle preceding "No Party Affiliation."





Democratic Party
Republican Party
Other Party
(Choose State-registered party here...)   
No Party Affiliation
Race/EthnicityAmerican Indian or Alaskan Native
Asian or Pacific Islander
Black, not Hispanic
Hispanic
White, not Hispanic

GenderM F
 

Do You Need Assistance to Vote?Yes   No
 


I am Active Duty Military/Merchant MarineYes No
 
 

I am a Dependent of Active Duty Military/Merchant MarineYes No
 
 

I am a US Citizen Residing Outside the US.Yes No