Fillable Printable Sample Voter ID Address Change Form
Fillable Printable Sample Voter ID Address Change Form
Sample Voter ID Address Change Form
Change in Voter Registration Information
For office use only
Voter ID Number: ________________________
Any registered elector may use this form to change his or her voter registration information. All fields marked with an asterisk (*) are required for your change
request to be complete. Mail, deliver, or scan and email your signed form to your county clerk and recorder.
Contact information is available online at: www.govotecolorado.com.
Change Requested (select all that apply)
Name Address Declare or change a political party affiliation
Your current contact information
Last name* First name* Middle name
Suffix
Current Street address (No P.O. Boxes)* Apt. or Unit City or Town* ZIP Code* Colorado County
When did you move to this address?* (MM/DD/YYYY)
Phone number (include area code)
Mailing address (required if different from your home address) Apt. or Unit
City or Town
State ZIP Code
Address where you would like your ballot delivered
(if different from your home or mailing address)
Apt. or Unit
City or Town State ZIP Code
Your identifying information
Your birthdate* (MM/DD/YYYY)
Your gender
MaleFemale
You must select one of the following and provide the requested information
I have a valid Colorado Driver's License or Colorado ID card (issued by the Dept. of Revenue) and that number is
-
-
I have not been issued a Colorado Driver's License or ID card, but I have a Social Security Number and the last 4 digits are
-
-
I do not have a Colorado Driver's License, ID card, or a Social Security Number.
Address change
Previous Street address (No P.O. Boxes) Apt. or Unit City or Town ZIP Code Colorado County
Name change
Middle nameFirst nameLast name
Select or change your political party affiliation
Current political party affiliation or status:
New political party affiliation (circle only one)
American Constitution Democratic Green Libertarian Republican Unity Unaffiliated
Election information by email
Would you like to receive election information by email?
(You will not receive a ballot by email).
Yes No
Email address
Sign or mark below
Signature or Mark*
Date*
(If you are unable to sign, you must make a mark and a witness to the
mark must sign here).
Date
Witness Signature
Warning: A violation of the self-affirmation you are about to make is a criminal act under the laws of this state and will subject you to the penalties provided by law.
It is a Class 1 misdemeanor to swear or affirm falsely as to your qualifications to vote.
I am aware that if I register to vote in Colorado I am also considered a resident of Colorado for motor vehicle registration and operation purposes and for income tax purposes.
Self-Affirmation: I affirm that I am a citizen of the United States; I have been a resident of the state of Colorado for at least twenty-two days immediately prior to an
election in which I intend to vote; and I am at least sixteen years old and understand that I must be eighteen years old to be eligible to vote. I further affirm that my present
address as stated h
erein is my sole legal place of residence, that I claim no other place as my legal residence, and that I understand that I am committing a felony if I knowingly
give false information regarding my place of present residence. I certify under penalty of perjury that I meet the registration qualifications; that the information I have provided
on this application is true to the best of my knowledge and belief; and that I have not, nor will I, cast more than one ballot in any election.
Secretary of State Approved 08-21-14
Form 125
[Article 2, Title 1, C.R.S.]
