8x17_VRC_English_SOS_2023.pdf

PERMIT NO. 85814

NO POSTAGE

NECESSARY

IF MAILED

IN THE

UNITED STATES

POSTAGE WILL BE PAID BY ADDRESSEE

B U S I N E S S R E P LY M A I L

FIRST-CLASS MAIL SACRAMENTO CA

California Voter Registration/Pre-registration Application

For election information in other languages, please visit:

www.sos.ca.gov, or call:

Yes. County elections officials mail vote-by-mail ballots to all active registered voters.

If sharing your address could put you in life threatening danger, you may be eligible to register to vote confidentially.

For more information, contact the Safe at Home program.

Safe at Home:

(877) 322-5227

Online:

SafeAtHome.sos.ca.gov

Yes! Check online at:

https://voterstatus.sos.ca.gov

• To vote in the next election, you must be at least 18 years old on Election Day and mail or deliver this card at least 15 days before the next election.

• If you miss the 15-day deadline, you can still register and vote. Contact your county elections official.

• 16- and 17-year-olds that pre-register to vote will automatically be registered voters when they turn 18.

• New voters that register by mail may have to show a form of identification the first time they vote, if they didn’t provide a driver license or SSN when registering.

• Once registered, you may vote for any candidate for state or congressional office, regardless of the candidate’s or your party preference or lack of party preference.

Contact the Secretary of State’s office:

• (800) 345-VOTE (8683)

• elections@sos.ca.gov

• www.sos.ca.gov/elections

• RegisterToVote.ca.gov

Or contact your local elections office.

Can I vote by mail in the next election?

Safe at Home

Can I check my voter registration status?Important Registration Information Questions, problems, or to report fraud?

(800) 232-8682

(800) 339-2857

(800) 339-8163

(866) 575-1558

(800) 339-2957

(800) 339-2865

(888) 345-2692

(888) 345-4917

(855) 345-3933

DR SHIRLEY N WEBER

SECRETARY OF STATE

ELECTIONS DIVISION

PO BOX 4045

SACRAMENTO CA 95812-9925

DR.SHIRLEYN.WEBER

SECRETARYOFSTATE

ELECTIONSDIVISION

150011THSTREET

SACRAMENTOCA95814-5701

(Rev.01/23)SOS23155363_68

SOS

Print clearly using blue or black ink. Use this form if you: (1) are a new voter, (2) are pre-registering to vote, (3) have changed your name, (4) have moved and need to update your voter registration address, or (5) want to change your political party preference. You can also register to vote online at RegisterToVote.ca.gov.

Did someone help you fill out or deliver this form?

If “yes,” the person who helped you must fill out and sign both parts of this blue box.

Org. name and phone #:

Org. name and phone #:

Name, address, and phone #:

Name, address, and phone #:

Signature

Signature

Date

Date

The address where you live Do not use a P.O. Box #

Signature Date Signed Month Day Year

First Middle

California countyStateCity

I swear or affirm that:

I am a U.S. citizen and a resident of California and at least 16 years old. I am not currently serving a state or federal prison term for the conviction of a felony. I am not currently found mentally incompetent to vote by a court.

I understand that it is a crime to intentionally provide incorrect information on this form. I declare under penalty of perjury under the laws of the State of California that the information on this form is true and correct.

Zip

Last (including suffix, such as Jr., Sr., III)

Home address Apt or Unit #

CA

California driver license or ID card #

M M D D Y Y Y Y

Email

SSN (last 4 numbers) X X X - X X -

Phone number

Date of birth

U.S. state or foreign country of birth

First name

Previous address City

Previous political party preference (if any) Previous countyZipState

Middle initial

Republican Party

American Independent Party

Green Party

Libertarian Party

Peace and Freedom Party

I want to choose a political party preference

I do not want to choose a political party preference

X

Democratic Party

No Party / None

Other (specify):

I am a U.S. citizen and resident of California

I am 18 or older

I am 16 or 17 and want to pre-register

If “No,” you CANNOT register.

Only choose one.

Yes

Yes

Yes No

No

No

Last name

California Voter Registration/Pre-Registration Application

All active registered voters will be mailed a vote-by-mail ballot for every election. If you want to vote in person, you must turn in your vote-by-mail ballot or you may be required to vote a provisional ballot.

Your legal name

240001

If you do not have a street address, describe where you live including cross streets, Route, N, S, E, W, etc.

Foreign countryStateCity Zip

Mailing address – if different from above or a P.O. Box #

Identification If you do not have a CA driver license or CA ID card, list the last 4 numbers of your Social Security Number (SSN), if you have one.

The address where you receive mail Skip if same as address above.

Registration history If you were previously registered or pre-registered to vote, fill out this section.

Political party preference

If you choose “No Party/None,” you may not be able to vote for some parties’ candidates at a primary election for U.S. President, or for a party’s central committee.

Optional voter information

Vote by mail in all elections

I want voting materials in an accessible format.

I want to be a poll worker.

Other language:

My ethnicity/race is:

My language preference for receiving election materials is:

English Español Spanish

Tagalog

Japanese 日本語

Hindi

Khmer Thai

(This part is the voter’s receipt.)

Tear here and fold. Tape to seal. Do not staple. The bottom part is your receipt.

Keep it until you receive a notice from your county elections official.

The law protects your voter registration information against commercial use.

Report any problems to the Secretary of State’s Voter Hotline: (800) 345-8683.

Qualifications

(optional)Mr. Mrs.Ms. Miss

Affidavit

Chinese 中文

Vietnamese Việt ngữ

Korean 한국어

You must sign in the red box for your registration to be complete.

When you return a vote-by-mail ballot, your signature on the return envelope must compare with your signature on this form or other signatures in your voter registration record.

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