16-152. Registration form

  1. The form used for the registration of electors shall contain:

    1. The date the registrant signed the form.

    2. The given name of the registrant, middle name, if any, and surname.

    3. Complete address of actual place of residence, including street name and number, apartment or space number, city or town and zip code, or such description of the location of the residence that it can be readily ascertained or identified.

    4. Complete mailing address, if different from residence address, including post office address, city or town, zip code or other designation used by the registrant for receiving mail.

    5. Party preference.

    6. Telephone number, unless unlisted.

    7. State or country of birth.

    8. Date of birth.

    9. Occupation.

    10. Indian census number (optional to registrant).

    11. Father's name or mother's maiden name.

    12. The last four digits of the registrant's social security number (optional to registrant).

    13. A statement as to whether or not the registrant is currently registered in another state, county or precinct, and if so, the name, address, county and state of previous registration.

    14. A statement that the registrant is a citizen of the United States.

    15. A statement that the registrant will be eighteen years of age on or before the date of the next general election.

    16. A statement that the registrant has not been convicted of treason or a felony, or if so, that the registrant's civil rights have been restored.

    17. A statement that the registrant is a resident of this state and of the county in which the registrant is registering.

    18. A statement that executing a false registration is a class 6 felony.

    19. The signature of the registrant.

    20. If the registrant is unable to sign the form, a statement that the affidavit was completed according to the registrant's direction.

    21. A statement that if an applicant declines to register to vote, the fact that the applicant has declined to register will remain confidential and will be used only for voter registration purposes.

    22. A statement that if an applicant does register to vote, the office at which the applicant submits a voter registration application will remain confidential and will be used only for voter registration purposes.

  2. A duplicate voter receipt shall be provided with the form that provides space for the name, street address and city of residence of the applicant, party preference and the date of signing. The voter receipt is evidence of valid registration for the purpose of casting a ballot to be verified as prescribed in section 16-584, subsection B.

  3. The state voter registration form shall be printed in a form prescribed by the secretary of state.

  4. The county recorder may establish procedures to verify whether a registrant has successfully petitioned the court for an injunction against harassment pursuant to section 12-1809 or an order of protection pursuant to section 12-1810 or 13-3602 and, if verified, to protect the registrant's residence address, telephone number or voting precinct number, if appropriate, from public disclosure.


WARNING - The above text was curent June 2003, but may be outdated now.