Please complete all of the information on the application. Print in ink or type. If you have any questions about how to fill out this application, please call the Secretary of State’s Office toll free at 1-800-252-VOTE (8683), TDD 1-800-735-2989.

    1. Complete questions on the upper right side of application. Indicate by checking the appropriate box, if this application is a new registration, a change of name or address, or request for replacement certificate. Answer all questions.

    2. Name – Give your full name including first, middle, and last. IF you have changed your name, give former name.

    3. Residence Address – Include street address, city, state, and zip. If you do not have a street address, give a description of the location of where you live.

    4. Mailing Address – If mail cannot be delivered to your residence, give a mailing address.

    5. Gender and Telephone Number – are optional. Your voter registration application is open to the public.

    6. Texas Driver’s License Number or Personal I.D. Number – (issued by the Department. of Public Safety). If none, give last 4 digits of your Social Security Number.

    7. City and County of Former Residence – If you were previously registered in another county in Texas, complete this box.

    8. Agent – An agent may apply for voter registration for another person as long as that person is related to the applicant as husband, wife, father, mother, son or daughter. The agent must also be a registered voter or have submitted an application of registration. Indicate the relationship of the agent on the application. Indicate relationship next to signature.

    9. Sign Your Name – If you cannot sign your name next to the X, a person may witness you making your mark. Give the name and address of the person who witnessed your mark above the signature line. If you cannot make a mark, have the witness state the applicant could not make a mark. You do not need a witness if you can sign your name.

The completed form should printed, signed, and mailed to:


Please Note: For a Voter Registration Application sent by FAX or email to be effective, the original application must be submitted by mail and be received by the registrar not later than the fourth business day after the transmission by FAX or email. You may fax your application to 972-547-1995 or email it to (Please include “Application was faxed” at the top of the application before you mail the original to our office.)

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