You can use this form to: register with any political party, place an “X” in

• Register to vote in the State of Florida the box preceding “NONE.” Florida is a closed
Florida Voter

• Change name or address
• Replace your defaced, lost or stolen Voter
primary election state. Therefore, to vote in a
primary election for partisan candidates, you
registration

Information Card
• Register with a political party or change
must be a registered voter in the party for which
a primary is being held. Regardless of party
Application
party affiliation
• Update your signature
affiliation, all registered voters can vote on issues
and non-partisan candidates.

DeaDline information notice

to rEgIStEr, you muSt:
• Be a citizen of the United States of America. (Box 2)
• Be a Florida resident. (Box 8) a voter registration agency, an armed forces
• Be 18 years old. (You may pre-register if you are 17 or recruitment office, the Division of Elections, or
if you have a valid driver’s license before your 17th
birthday.) (Box 5)
• Not be adjudicated mentally incapacitated with respect
to voting unless that right is restored. (Box 4)
• Not be a convicted felon unless you have had your civil
rights restored. (Box 3)
• Provide your current and valid Florida driver’s license
number or florida identification card number. If you
do not have a current and valid florida driver’s license
or florida identification card, you must provide the
last four digits of your social security number. If you
do not have a florida driver’s license number, florida
identification card number or social security number,
write “NONe” in the box. (Box 6)
• Complete all information in the black boxes on the ap­
plication. (Boxes 2, 3, 4, 5, 6, 7, 8, 16)
If this is a new registration application in Florida,
the date the completed application is postmarked
or hand delivered to a driver’s license office,
the office of any supervisor of elections in the
state will be your registration date. You must be
registered for at least 29 days before you can vote
in an election. If your application is complete and
you are qualified as a voter, a voter information
card will be mailed to you.
PartY affiliation (Box #12)
If you wish to register with a major political
party, place an “X” in the box next to the desired
major party. If you wish to register with a minor
political party, place an “X” in the box preceding
“minor party” and then print the name of the
desired minor party. For a list of all political
parties registered in Florida, go to the Division
of Elections’ web site: http://election.dos.state.
fl.us/online/parties.shtml. If you do not wish to
The office at which you register or your decision
not to register, your SSN, your FL DL# and your
FL ID card# will remain confidential and will be
used only for voter registration purposes.
note
If the information on this application is not true,
the applicant can be convicted of a felony of
the third degree and fined up to $5,000 and/or
imprisoned for up to five years.
Questions
Contact the office of your county supervisor of
elections for additional information. Contact
information is on the website for the Division of
Elections: http://election.dos.state.fl.us/county/
index.shtml
información en esPañol
Sirvase llamar a la oficina del supervisor de
elecciones de su condado si le interesa obtener
este formulario en Español.

PLEASE ComPLEtE tHE APPLICAtIoN BELoW. PLEASE PrINt uSINg A BLACk BALLPoINt PEN.
1) black boxes must be completed on the application below for registration to be valid. 2) return this completed application to the office of your supervisor of elections.
3) If you are a first-time voter in this state applying by mail to register to vote and you have not been issued a fl dl#, fl Id#, or ssN, include a copy of your Id with the application (see
special Identification requirements for additional information required). 4) mail with first-class stamp.

rEVISED 1/08 Florida Voter registration application

OFFICIAL USE ONLY:
1 Check boxes that apply:  New Registration  Address Change  Party Change  Name Change  Card Replacement  Signature Update DS DE 39 1/08

2 Are you a citizen of the United States of America? Yes No (If NO, you cannot register to vote)

3  I affirm I am not a convicted felon, or if I am, my rights relating to voting have been restored.

4 I affirm I have not been adjudicated mentally incapacitated with respect to voting or, if I have, my right to vote has been restored.
If yOu aNswered NO tO questION 2, Or If yOu are uNable tO affIrm the statemeNts IN bOxes 3 aNd 4,
reQUired

yOu are INelIgIble tO regIster tO vOte. dO NOt cOmplete thIs applIcatION.

5
Date of Birth
(MM/DD/YYYY) / /
If you have a current and valid FL DL# or FL ID card#, you must provide the number in this box. If you do not have
6 either, provide the last 4 digits of your SSN. If you have not been issued a FL DL#, FL ID card#, or SSN, write “NONE”:

Last Name
Suffix (circle) None First Name Middle Name/Initial
7 Jr. Sr. II III IV

Address Where You Live (Legal Residence) DO NOT GIVE P.O. BOX.
Apt/Lot/Unit City County of Legal Residence State Zip Code
8 FL
Mailing Address If Different from Above Apt/Lot/Unit City Country State Zip Code
9
Address Last Registered to Vote Apt/Lot/Unit City County State Zip Code
10
Former Name if Making Name Change Day Phone Number (optional)
11

12 Party Affiliation (Check only one) Democratic Party Republican Party minor party (print registered party name): NONE

13 Race/Ethnicity (Check only one) American Indian/Alaskan Native Asian/Pacific Islander Black, not Hispanic Hispanic White, not Hispanic
State or Country of Birth
14 Sex M F Do you need voting assistance at the polls? Yes No Are you interested in being a poll worker? Yes No

15 Are You: Active Duty Military/Merchant Marine Dependent of Active Duty Military/Merchant Marine U.S. Citizen Currently Residing Outside the U.S.

sIgNature: Sign or mark on line in box below. (Invalid without signature or mark of applicant)
Oath: I do solemnly swear (or affirm) that I will protect and defend the

reQUired

Constitution of the United States and the Constitution of the State of Florida, that

16 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. X Date:
mAIL your LAFAyEttE CouNty
Supervisor of Elections
PASCo CouNty
Supervisor of Elections SPECIAL
APPLICAtIoN
PO Box 76 PO Box 300
Mayo FL 32066
386-294-1261
Dade City FL 33526-0300
352-521-4302 IDENtIFICAtIoN
address your envelope to your county
supervisor of elections.
LAkE CouNty
Supervisor of Elections
PO Box 457
PINELLAS CouNty
Supervisor of Elections
13001 Starkey Road
rEQuIrEmENtS
Tavares FL 32778-0457 Largo FL 33773-1416
352-343-9734 727-464-6108
If you are registering by mail, you have never voted
ALACHuA CouNty FLAgLEr CouNty LEE CouNty PoLk CouNty
Supervisor of Elections Supervisor of Elections Supervisor of Elections Supervisor of Elections
in Florida, and you have not been issued a Florida
PO Box 1496 PO Box 901 PO Box 2545 PO Box 1460
Gainesville FL 32602-1496 Bunnell FL 32110-0901 Fort Myers FL 33902 Bartow FL 33831-1460
driver’s license, Florida identification card, or Social
352-374-5252 386-313-4170 239-533-VOTE (8683) 863-534-5888 Security number, you will be required to provide
BAkEr CouNty FrANkLIN CouNty LEoN CouNty PutNAm CouNty additional identification prior to voting the first
Supervisor of Elections Supervisor of Elections Supervisor of Elections Supervisor of Elections
PO Box 505 47 Ave. F PO Box 7357 2509 Crill Ave., Suite 900 time. To ensure that you will not have problems
Macclenny FL 32063 Apalachicola FL 32320 Tallahassee FL 32314-7357 Palatka FL 32177
904-259-6339 850-653-9520 850-606-VOTE (8683) 386-329-0224 when you go to vote, you should provide a copy of
BAy CouNty gADSDEN CouNty LEVy CouNty SANtA roSA CouNty the required identification listed below at the time
Supervisor of Elections Supervisor of Elections Supervisor of Elections Supervisor of Elections
205 Mosley Drive PO Box 186 421 S. Court St. 6495 Caroline St., Suite F you mail your voter registration application.
Lynn Haven FL 32444 Quincy FL 32353 Bronson FL 32621 Milton FL 32570-4592
850-784-6100 850-627-9910 352-486-5163 850-983-1900

BrADForD CouNty gILCHrISt CouNty LIBErty CouNty SArASotA CouNty

You may provide a copy of one of
Supervisor of Elections
PO Box 58
Supervisor of Elections
112 S. Main St., Room 128
Supervisor of Elections
PO Box 597
Supervisor of Elections
PO Box 4194
the following photo identifications
Starke FL 32091
904-966-6266
Trenton FL 32693
352-463-3194
Bristol FL 32321 Sarasota FL 34230-4194 (ID) that includes your name and
850-643-5226 941-861-8600
picture:
BrEVArD CouNty gLADES CouNty mADISoN CouNty SEmINoLE CouNty
Supervisor of Elections Supervisor of Elections Supervisor of Elections Supervisor of Elections
PO Box 1119 PO Box 668 229 SW Pinckney St., Room 113 PO Box 1479 • U.S. Passport • Employee Badge or ID
Titusville FL 32781-1119 Moore Haven FL 33471 Madison FL 32340 Sanford FL 32772-1479
321-264-6740 863-946-6005 850-973-6507 407-585-VOTE (8683) • Buyers Club ID • Debit/Credit Card
BroWArD CouNty guLF CouNty mANAtEE CouNty St. JoHNS CouNty • Military ID • Student ID
Supervisor of Elections Supervisor of Elections Supervisor of Elections Supervisor of Elections
PO Box 029001 401 Long Ave. PO Box 1000 4455 Ave. A, Suite 101
• Retirement Center ID
Fort Lauderdale FL 33302 Port St. Joe FL 32456-1707 Bradenton FL 34206 St. Augustine FL 32095
954-357-7050 850-229-6117 941-741-3823 904-823-2238
• Neighborhood Association ID
CALHouN CouNty
• Public Assistance ID
HAmILtoN CouNty mArIoN CouNty St. LuCIE CouNty
Supervisor of Elections Supervisor of Elections Supervisor of Elections Supervisor of Elections
20859 Central Ave. E., Room G10 1153 US Hwy. 41 NW, Suite 1 PO Box 289 4132 Okeechobee Road
Blountstown FL 32424 Jasper FL 32052 Ocala FL 34478-0289 Fort Pierce FL 34947 Or, you may provide a copy of one
850-674-8568 386-792-1426 352-620-3290 772-462-1500
of the following documents that
CHArLottE CouNty HArDEE CouNty mArtIN CouNty SumtEr CouNty
Supervisor of Elections Supervisor of Elections Supervisor of Elections Supervisor of Elections contains your name and current
PO Box 511229 311 N. 6th Ave. PO Box 1257 900 N. Main St.
Punta Gorda FL 33951-1229 Wauchula FL 33873 Stuart FL 34995 Bushnell FL 33513 residence address:
941-637-2232 863-773-6061 772-288-5637 352-793-0230

CItruS CouNty HENDry CouNty mIAmI-DADE CouNty SuWANNEE CouNty

• Bank Statement • Paycheck
Supervisor of Elections Supervisor of Elections Supervisor of Elections Supervisor of Elections • Government Check • Utility Bill
120 N. Apopka Ave. PO Box 174 PO Box 521550 220 Pine Ave. SW
Inverness FL 34450 LaBelle FL 33975 Miami FL 33152-1550 Live Oak FL 32064 • Other Government Document
352-341-6740 863-675-5230 305-499-VOTE (8683) 386-362-2616

CLAy CouNty HErNANDo CouNty moNroE CouNty tAyLor CouNty

Supervisor of Elections Supervisor of Elections Supervisor of Elections Supervisor of Elections Or, if you are one of the following
PO Box 337 20 N. Main St., Room 165 530 Whitehead St., Suite 101 PO Box 1060
Green Cove Springs FL 32043-0337 Brooksville FL 34601 Key West FL 33040-6577 Perry FL 32348 persons, you are exempt from
904-284-6350 352-754-4125 305-292-3416 850-838-3515
having to provide a copy of an ID at
CoLLIEr CouNty HIgHLANDS CouNty NASSAu CouNty uNIoN CouNty
Supervisor of Elections Supervisor of Elections Supervisor of Elections Supervisor of Elections this time. These exemptions are:
3301 Tamiami Trail E., PO Drawer 3448 96135 Nassau Place, Suite 3 55 W. Main St., Room 106
Rev. Dr. MLK Jr. Bldg. Sebring FL 33871 Yulee FL 32097 Lake Butler FL 32054
Naples FL 34112 863-402-6655 904-491-7500 386-496-2236
• Persons 65 years of age or older
239-252-8450 • Persons with a temporary or permanent
HILLSBorougH CouNty okALooSA CouNty VoLuSIA CouNty
CoLumBIA CouNty Supervisor of Elections Supervisor of Elections Supervisor of Elections physical disability
Supervisor of Elections 601 E. Kennedy Blvd., 16th Floor 302 Wilson St. N., Suite 102 125 W. New York Ave.
971 W. Duval St., Suite 102 Tampa FL 33602 Crestview FL 32536-3440 DeLand FL 32720-4208 • Members of the active uniformed service
Lake City FL 32055-3737 813-272-5850 850-689-5600 386-736-5930
386-758-1026 or merchant marine who, by reason of such
HoLmES CouNty okEECHoBEE CouNty WAkuLLA CouNty
DESoto CouNty Supervisor of Elections Supervisor of Elections Supervisor of Elections active duty, are absent from the county
Supervisor of Elections 201 N. Oklahoma St., Suite 102 304 NW 2nd St., Room 101 PO Box 305
PO Box 89 Bonifay FL 32425 Okeechobee FL 34972 Crawfordville FL 32326-0305 • Spouse or dependent of an active uniformed
Arcadia FL 34265 850-547-1107 863-763-4014 850-926-7575
863-993-4871 service member or merchant marine who,
INDIAN rIVEr CouNty orANgE CouNty WALtoN CouNty
DIXIE CouNty Supervisor of Elections Supervisor of Elections Supervisor of Elections
by reason of the active duty or service of the
Supervisor of Elections 4375 43rd Ave., Unit 101 PO Box 562001 571 E. Nelson Ave. (US Hwy. 90) member, is absent from the county
PO Box 2057 Vero Beach FL 32967 Orlando FL 32856 DeFuniak Springs FL 32433
Cross City FL 32628 772-226-3440 407-836-2070 850-892-8112 • Persons currently residing outside the U.S.
352-498-1216
JACkSoN CouNty oSCEoLA CouNty WASHINgtoN CouNty who are eligible to vote in Florida
DuVAL CouNty Supervisor of Elections Supervisor of Elections Supervisor of Elections
Supervisor of Elections PO Box 6046 2509 E. Irlo Bronson Memorial Hwy. 1331 South Blvd., Suite 900
105 E. Monroe St. Marianna FL 32447 Kissimmee FL 34744 Chipley FL 32428
Jacksonville FL 32202
904-630-1414
850-482-9652 407-742-6000 850-638-6230 DO NOT SEND ORIGINAL
JEFFErSoN CouNty PALm BEACH CouNty
ESCAmBIA CouNty Supervisor of Elections Supervisor of Elections IDENTIFICATION DOCUMENTS TO
Supervisor of Elections 380 W. Dogwood St. PO Box 22309
PO Box 12601 Monticello FL 32344 West Palm Beach FL 33416 THE SUPERVISOR OF ELECTIONS.
Pensacola FL 32591-2601 850-997-3348 561-656-6200
850-595-3900