Fillable Printable Florida Voter Registration Application
Fillable Printable Florida Voter Registration Application
Florida Voter Registration Application
Florida Voter Registration Application
Part 1 – Instructions (DS-DE 39, R1S-2.040, F.A.C.)(eff. 10/2013)
Información en español: Sirvase llamar a la oficina del supervisor de
elecciones de su condado si le interesa obtener este formulario en español.
To Register in Florida, you must be:
•
a U.S. citizen,
•
a Florida resident,
•
at least 18 years old (you may pre-register at 16 or 17,
but cannot vote until you are 18).
If you have been convicted of a felony, or if a court has
found you to be mentally incapacitated as to your right to
vote, you cannot register until your right to vote is restored.
If you do not meet any ONE of these requirements, you
are not eligible to register.
Questions?
Contact the Supervisor of Elections in your county:
Visit the Florida Division of Elections’ website at:
Where to Register: You can register to vote by completing this application and delivering it in person or by mail to
any supervisor of elections’ office, office that issues driver’s licenses, or voter registration agency (public assistance
office, center for independent living, office serving persons with disabilities, public library, or armed forces recruitment
office) or the Division of Elections. Mailing addresses are on page 2 of this form.
Deadline to Register: The deadline to register to vote is 29 days before any election. You can update your
registration record at any time, but for a Primary Election, party changes must be completed 29 days before that
election. You will be contacted if your new application is incomplete, denied or a duplicate of an existing registration.
Your Voter Information Card will be mailed to you once you are registered.
Identification (ID) Requirements: New applicants must provide a current and valid Florida driver’s license number
(FL DL#) or Florida identification card number (FL ID#). If you do not have a FL DL# or FL ID#, then you must provide
the last four digits of your Social Security number (SSN). If you do not have any of these numbers, check “None.” If
you leave the field and box blank, your new registration may be denied. See section 97.053(6), Fla.Stat.
Special ID requirements: If you are registering by mail, have never voted in Florida, and have never been issued one
of the ID numbers above, include one of the following with your application, or at a later time before you vote: 1) A
copy of an ID that shows your name and photo (acceptable IDs--U.S. Passport, debit or credit card, military ID,
student ID, retirement center ID, neighborhood association ID, or public assistance ID); or 2) A copy of an ID that
shows your name and current residence address (acceptable documents--utility bill, bank statement, government
check, paycheck, or other government document).
The special ID is not required if you are 65 or older, have a temporary or permanent physical disability, are a member
of the active uniformed services or merchant marine who is absent from the county for active duty, or a spouse or
dependent thereof, or are currently living outside the U.S. but otherwise eligible to vote in Florida.
Political Party Affiliation: Florida is a closed primary election state. In primary elections, registered voters can only
vote for their registered party’s candidates in a partisan race on the ballot. In a primary election, all registered voters,
regardless of party affiliation, can vote on any issue, nonpartisan race, and race where a candidate faces no
opposition in the General Election. If you do not indicate your party affiliation, you will be registered with no party
affiliation. For a list of political parties, visit the Division of Elections’ website at: http://election.dos.state.fl.us/
Race/Ethnicity: It is optional to list your race or ethnicity.
Boxes: Please check boxes (
) where applicable.
CRIMINAL OFFENSE: It is a 3rd degree felony to submit
false information. Maximum penalties are $5,000 and/or 5
years in prison.
PUBLIC RECORD: Once filed, all information including your
phone number and email address as provided become
public record except for the following which can only be
used for voter registration purposes: your FL DL#, FL ID#,
SSN, where you registered to vote, and whether you
declined to register or to update your voter registration
record at a voter registration agency. Your signature can be
viewed but not copied. (Section 97.0585, Fla. Stat.)
Numbered rows 1 through 7 and 12 must be completed for a new registration.
Florida Voter Registration Application
Part 2 – Form (DS-DE #39, R1S-2.040, F.A.C.)(eff. 10/2013)
The downloadable/printable online form is available at:
This is:
New Registration
Record Update/Change (e.g., Address, Party Affiliation, Name, Signature)
Request to Replace Voter Information Card
1 Are you a citizen of the United States of America?
YES
NO
OFFICIAL USE ONLY
FVRS No:
2
I affirm that I am not a convicted felon, or if I am, my right to vote has been restored.
3
I affirm that I have not been adjudicated mentally incapacitated with respect to voting
or, if I have, my right to vote has been restored.
4
Date of Birth (
MM-DD-YYYY)
- -
5
Florida Driver License (FL DL) or Florida identification (FL ID) Card Number
If no FL
DL or FL
ID, then
provide
Last 4 digits of Social
Security Number
I have
NONE of
these
numbers
.
-
-
-
-
6
Last Name
First Name Middle Name Name Suffix
(Jr., Sr., I, II, etc.):
7
Address Where You Live (legal residence-no P.O. Box)
Apt/Lot/Unit City County Zip Code
8
Mailing Address (if different from above address)
Apt/Lot/Unit City State or Country Zip Code
9
Address Where You Were Last Registered to Vote
Apt/Lot/Unit City State Zip Code
10
Former Name (if name is changed) Gender
M F
State or Country of Birth Telephone No. (optional)
( )
11
Email me SAMPLE BALLOTS if option is available in my county.
(See Public Record Notice above) My email address is:
Party Affiliation
(Check only one. If left blank, you will
be registered without party affiliation)
Florida Democratic Party
Republican Party of Florida
No party affiliation
Minor party (print party name):
______________________
12
Race/Ethnicity (Check only one)
American Indian/Alaskan Native
Asian/Pacific Islander
Black, not of Hispanic Origin
Hispanic
White, not of Hispanic Origin
Multi-racial
Other:
________________
(Check only one if applicable)
I am an active duty Uniformed Services or Merchant
Marine member
I am a spouse or a dependent of an active duty uniformed
services or merchant marine member
I am a U.S. citizen residing outside the U.S.
I will
need
assistance
with voting.
I am
interested in
becoming a
poll worker.
Oath: I do solemnly swear (or affirm) that I will protect
and defend the Constitution of the United States and
the Constitution of the State of Florida, that I am
qualified to register as an elector under the
Constitution and laws of the State of Florida, and that
all information provided in this application is true.
SIGN/
MARK
HERE
Date
http://election.dos.state.fl.us/SOE/supervisor_elections.shtml
http://election.dos.state.fl.us.
http://election.dos.state.fl.us/pdf/webappform.pdf
Address your envelope to
your County Supervisor of
Elections.
(Updated 7/17/2014)
FLAGLER COUNTY
Supervisor of Elections
PO Box 901
Bunnell FL 32110-0901
386-313-4170
FRANKLIN COUNTY
Supervisor of Elections
47 Ave. F
Apalachicola FL 32320-2311
850-653-9520
GADSDEN COUNTY
Supervisor of Elections
PO Box 186
Quincy FL 32353
850-627-9910
GILCHRIST COUNTY
Supervisor of Elections
112 S. Main St., Room 128
Trenton FL 32693-3249
352-463-3194
GLADES COUNTY
Supervisor of Elections
PO Box 668
Moore Haven FL 33471-0668
863-946-6005
GULF COUNTY
Supervisor of Elections
401 Long Ave.
Port St. Joe FL 32456-1707
850-229-6117
HAMILTON COUNTY
Supervisor of Elections
1153 US Hwy. 41 NW, Suite 1
Jasper FL 32052-5856
386-792-1426
HARDEE COUNTY
Supervisor of Elections
311 N. 6th Ave.
Wauchula FL 33873-2361
863-773-6061
HENDRY COUNTY
Supervisor of Elections
PO Box 174
LaBelle FL 33975-0174
863-675-5230
HERNANDO COUNTY
Supervisor of Elections
20 N. Main St., Room 165
Brooksville FL 34601-2864
352-754-4125
HIGHLANDS COUNTY
Supervisor of Elections
PO Box 3448
Sebring FL 33871-3448
863-402-6655
HILLSBOROUGH COUNTY
Supervisor of Elections
2514 N Falkenberg Rd
Tampa FL 33619-0917
813-272-5850
HOLMES COUNTY
Supervisor of Elections
201 N. Oklahoma St., Suite 102
Bonifay FL 32425-2243
850-547-1107
INDIAN RIVER COUNTY
Supervisor of Elections
4375 43rd Ave.
Vero Beach FL 32967-1024
772-226-3440
JACKSON COUNTY
Supervisor of Elections
PO Box 6046
Marianna FL 32447-6046
850-482-9652
JEFFERSON COUNTY
Supervisor of Elections
380 W. Dogwood St.
Monticello FL 32344-1470
850-997-3348
LAFAYETTE COUNTY
Supervisor of Elections
PO Box 76
Mayo FL 32066-0076
386-294-1261
LAKE COUNTY
Supervisor of Elections
PO Box 457
Tavares FL 32778-0457
352-343-9734
LEE COUNTY
Supervisor of Elections
PO Box 2545
Fort Myers FL 33902-2545
239-533-VOTE (8683)
LEON COUNTY
Supervisor of Elections
PO Box 7357
Tallahassee FL 32314-7357
850-606-VOTE (8683)
LEVY COUNTY
Supervisor of Elections
421 S. Court St.
Bronson FL 32621-6520
352-486-5163
LIBERTY COUNTY
Supervisor of Elections
PO Box 597
Bristol FL 32321-0597
850-643-5226
MADISON COUNTY
Supervisor of Elections
239 SW Pinckney St.
Madison FL 32340
850-973-6507
MANATEE COUNTY
Supervisor of Elections
PO Box 1000
Bradenton FL 34206-1000
941-741-3823
MARION COUNTY
Supervisor of Elections
PO Box 289
Ocala FL 34478-0289
352-620-3290
MARTIN COUNTY
Supervisor of Elections
PO Box 1257
Stuart FL 34995-1257
772-288-5637
MIAMI-DADE COUNTY
Supervisor of Elections
PO Box 521550
Miami FL 33152-1550
305-499-VOTE (8683)
MONROE COUNTY
Supervisor of Elections
530 Whitehead St., Suite 101
Key West FL 33040-6577
305-292-3416
NASSAU COUNTY
Supervisor of Elections
96135 Nassau Place, Suite 3
Yulee FL 32097-8635
904-491-7500
OKALOOSA COUNTY
Supervisor of Elections
302 Wilson St. N., Suite 102
Crestview FL 32536-3440
850-689-5600
OKEECHOBEE COUNTY
Supervisor of Elections
304 NW 2nd St., Room 144
Okeechobee FL 34972-4120
863-763-4014
ORANGE COUNTY
Supervisor of Elections
PO Box 562001
Orlando FL 32856-2001
407-836-2070
OSCEOLA COUNTY
Supervisor of Elections
2509 E. Irlo Bronson Memorial Hwy.
Kissimmee FL 34744-4909
407-742-6000
PALM BEACH COUNTY
Supervisor of Elections
PO Box 22309
West Palm Beach FL 33416-2309
561-656-6200
PASCO COUNTY
Supervisor of Elections
PO Box 300
Dade City FL 33526-0300
352-521-4302
PINELLAS COUNTY
Supervisor of Elections
13001 Starkey Road
Largo FL 33773-1416
727-464-VOTE (8683)
POLK COUNTY
Supervisor of Elections
PO Box 1460
Bartow FL 33831-1460
863-534-5888
PUTNAM COUNTY
Supervisor of Elections
2509 Crill Ave., Suite 900
Palatka FL 32177-4267
386-329-0224
SANTA ROSA COUNTY
Supervisor of Elections
6495 Caroline St., Suite F
Milton FL 32570-4592
850-983-1900
SARASOTA COUNTY
Supervisor of Elections
PO Box 4194
Sarasota FL 34230-4194
941-861-8600
SEMINOLE COUNTY
Supervisor of Elections
PO Box 1479
Sanford FL 32772-1479
407-585-VOTE (8683)
ST. JOHNS COUNTY
Supervisor of Elections
4455 Ave. A, Suite 101
St. Augustine FL 32095-5200
904-823-2238
ST. LUCIE COUNTY
Supervisor of Elections
4132 Okeechobee Road
Fort Pierce FL 34947
772-462-1500
SUMTER COUNTY
Supervisor of Elections
900 N. Main St.
Bushnell FL 33513-5008
352-569-1540
SUWANNEE COUNTY
Supervisor of Elections
220 Pine Ave. SW
Live Oak FL 32064-2315
386-362-2616
TAYLOR COUNTY
Supervisor of Elections
PO Box 1060
Perry FL 32348-1060
850-838-3515
UNION COUNTY
Supervisor of Elections
175 W. Main St.
Lake Butler FL 32054
386-496-2236
VOLUSIA COUNTY
Supervisor of Elections
125 W. New York Ave.
DeLand FL 32720-5415
386-736-5930
WAKULLA COUNTY
Supervisor of Elections
PO Box 305
Crawfordville FL 32326-0305
850-926-7575
WALTON COUNTY
Supervisor of Elections
571 E. Nelson Ave. (US Hwy. 90)
DeFuniak Springs FL 32433-1378
850-892-8112
WASHINGTON COUNTY
Supervisor of Elections
1331 South Blvd., Suite 900
Chipley FL 32428-2233
850-638-6230
ALACHUA COUNTY
Supervisor of Elections
111 SE 1
st
Avenue
Gainesville, FL 32601-6819
352-374-5252
BAKER COUNTY
Supervisor of Elections
PO Box 505
MacClenny FL 32063-0505
904-259-6339
BAY COUNTY
Supervisor of Elections
830 W. 11th St.
Panama City FL 32401
850-784-6100
BRADFORD COUNTY
Supervisor of Elections
PO Box 58
Starke FL 32091-2110
904-966-6266
BREVARD COUNTY
Supervisor of Elections
PO Box 410819
Melbourne FL 32941-0819
321-264-6740
BROWARD COUNTY
PO Box 029001
Fort Lauderdale FL 33302
954-357-7050
CALHOUN COUNTY
Supervisor of Elections
20859 Central Ave. E., Rm 117
Blountstown FL 32424-2264
850-674-8568
CHARLOTTE COUNTY
Supervisor of Elections
226 Taylor Street, Unit 120
Punta Gorda FL 33950
941-833-5400
CITRUS COUNTY
Supervisor of Elections
120 N. Apopka Ave.
Inverness FL 34450-4238
352-341-6740
CLAY COUNTY
Supervisor of Elections
PO Box 337
Green Cove Springs FL 32043-0337
904-284-6350
COLLIER COUNTY
Supervisor of Elections
Rev Dr MLK Jr Bldg
3295 Tamiami Trail E
Naples FL 34112-5758
239-252-VOTE (8683)
COLUMBIA COUNTY
Supervisor of Elections
971 W. Duval St., Suite 102
Lake City FL 32055-3734
386-758-1026
DESOTO COUNTY
Supervisor of Elections
PO Box 89
Arcadia FL 34265-4451
863-993-4871
DIXIE COUNTY
Supervisor of Elections
PO Box 2057
Cross City FL 32628-2057
352-498-1216
DUVAL COUNTY
Supervisor of Elections
105 E. Monroe St.
Jacksonville FL 32202-3215
904-630-1414
ESCAMBIA COUNTY
Supervisor of Elections
PO Box 12601
Pensacola FL 32591-2601
850-595-3900
Supervisor of Elections
