INSTRUCTIONS FOR COMPLETING ...

INSTRUCTIONS FOR COMPLETING & SUBMITTING

VOTER REGISTRATION APPLICATION FORM

YOU MAY USE THIS FORM TO: REGISTER TO VOTE IN WYOMING OR TO CHANGE YOUR REGISTRATION (NAME, ADDRESS OR PARTY)

Register at the county clerk's office: Print out the form & sign it in front of any registry agent.

OR

Register by mail: Voters who are not currently in Wyoming or who cannot go to the County Clerk's office may register by mail. Follow the instructions below to mail in your voter registration application:

1. Print out the voter registration form and fill it out in front of a notary or person authorized to administer oaths. Print clearly, using a black or blue ink pen (not felt tip).

2. Show identification to the notary or registry agent. See list of acceptable documents below:

Preferred identification

Valid Wyoming driver's license

Second option if you don't have valid Wyoming driver's license

Different state's driver's license; ID issued by a local, state or federal agency; U.S. passport; school ID; military ID

Third option: 2 of any of the following documents

Certificate of US citizenship or naturalization; draft record; voter registration card from another state or county; original or certified copy of birth certificate bearing an official seal; certificate of birth abroad issued by U.S. State Department; any other form of ID issued by an official agency

3. Sign the voter registration oath on the form and have the notary or registered agent sign the form. 4. Make copies of the identification documents you showed to the notary. 5. Mail the voter registration form, along with the copies of your ID documents, to your County Clerk.

Note: Sending your form to any other office will delay your voter registration. 6. Mail your form as soon as possible. Voter registration closes two weeks prior to an election. 7. Follow up with your County Clerk about any questions you may have about your registration or requests for

absentee ballots. See for contact details.

WYOMING COUNTY CLERKS

Albany County Clerk 425 Grand Ave, Ste 202 Laramie, WY 820707

Hot Springs County Clerk 415 Arapahoe Thermopolis, WY 82443-2783

Sheridan County Clerk 224 S Main St, Ste 17 Sheridan, WY 82801-4855

Big Horn County Clerk

Johnson County Clerk

County Courthouse, PO Box 31 76 N Main St

Basin, WY 82410-0031

Buffalo, WY 82834-1883

Sublette County Clerk PO Box 250 Pinedale, WY 82941-0250

Campbell County Clerk PO Box 3010 Gillette, WY 82717-3010

Laramie County Clerk PO Box 608 Cheyenne, WY 82003-0608

Sweetwater County Clerk 80 W Flaming Gorge Way, Ste 155 Green River, WY 82935

Carbon County Clerk PO Box 6 Rawlins, WY 82301-0006

Lincoln County Clerk J925 Sage Ave, Ste 101 Kemmerer, WY 83101

Teton County Clerk PO Box 1727 Jackson, WY 83001-1727

Converse County Clerk 107 N 5th St, Ste 114 Douglas, WY 82633-2448

Crook County Clerk PO Box 37 Sundance, WY 82729-0037

Fremont County Clerk 450 N 2nd St, Rm 220 Lander, Wy 82520-0090

Goshen County Clerk PO Box 160 Torrington, WY 82240-0160

Natrona County Clerk PO Box 863 Casper, WY 82601-0863

Niobrara County Clerk PO Box 420 Lusk, WY 82225-0420

Park County Clerk 1002 Sheridan Cody, WY 82414-3589

Platte County Clerk PO Drawer 728 Wheatland, WY 82201-0728

Uinta County Clerk PO Box 810 Evanston, Wy 82930-0810

Washakie County Clerk 1001 Big Horn Ave PO Box 260 Worland, WY 82401

Weston County Clerk 1 W Main Newcastle, WY 82701-2121

Wyoming Voter Registration Application & Change Form

New Voter Application

Name Change

1. Name and Date of Birth Legal Last Name Date of Birth

Change to Current Registration

Legal First Name County Resident Since

VR # ___________________ County # ________ District _________ Precinct _________ Split __________ School __________ House __________ Senate_________ Municipality __________ Ward ____________

Legal Middle Name

Suffix

2. Wyoming Driver's License You must provide this number if you hold a valid Wyoming Driver's License Valid Wyoming Driver's License Number:

Mark here only if you do not have a valid Wyoming Driver's License and go to step 2a. 2a. Social Security Number Last four digits are required if you do not have a valid Wyoming Driver's License Social Security Number

Mark here only if you do not have a valid Wyoming Driver's License or a Social Security Number.

3. Personal Information * Denotes optional information

Gender* Male Wyoming Residence Address (No P.O. Box Numbers)

City

Female

Address Where You Get Your Mail

Mailing

State

City

Zip Zip

Phone*

Are you interested in being an Election Judge?* Yes No

E-mail*

Do you need assistance to vote? *

Yes No

4. Political Party Choose one of the following

Republican

Democratic

Libertarian

Constitution

5. Changes to Current Wyoming Voter Registration

Former Wyoming Residence

City

Street Address

WY County

Former Last Name

Former First Name

5a. Withdrawal of Voter Registration from Another State Residence address in prior State

Street Address

City

County

State Wyoming Former Middle Name

State

Unaffiliated Zip Suffix Zip

6. Registration Oath and Acknowledgement Required on all applications. I do solemnly swear (or affirm) that I am a citizen of the United States; that I am a bona fide resident of the state of Wyoming and this county; that if registered in another county or state, I hereby request that my registration be withdrawn; that I will be at least eighteen (18) years of age on or before the next election; that I am not currently adjudicated a mentally incompetent person; that I have not been convicted of a felony, or if I have been convicted of a felony, I have had my civil or voting rights restored by a competent authority; and that the voter registration information contained herein is true and accurate to my best knowledge and belief.

Sign your legal name in full

Proof of Identification Shown

Type of Identification

Subscribed and affirmed or sworn to before me by

__________________________________________________________ (name of applicant) on ____________________________ (application date)

Title Signature & Title of Registry Agent or person authorized to administer oaths

3/2014

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