Florida Voter
registration
Application
to rEgIStEr, you muSt:
• Be a citizen of the United States of America. (Box 2)
• Be a Florida resident. (Box 8)
• Be 18 years old. (You may pre-register if you are 17 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)
You can use this form to:
• Register to vote in the State of Florida
• Change name or address
• Replace your defaced, lost or stolen Voter
Information Card
• Register with a political party or change
party affiliation
• Update your signature
register with any political party, place an “X” in
the box preceding “NONE.” Florida is a closed
primary election state. Therefore, to vote in a
primary election for partisan candidates, you
must be a registered voter in the party for which
a primary is being held. Regardless of party
affiliation, all registered voters can vote on issues
and non-partisan candidates.
DeaDline information
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,
a voter registration agency, an armed forces
recruitment office, the Division of Elections, or
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.
notice
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.
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
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.
Florida Voter registration application
rEVISED 1/08
Check boxes that apply:
2
Are you a citizen of the United States of America? Yes
3
 I affirm I am not a convicted felon, or if I am, my rights relating to voting have been restored.
reQUired
4
No
OFFICIAL USE ONLY:
DS DE 39 1/08
(If NO, you cannot register to vote)
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,
yOu are INelIgIble tO regIster tO vOte. dO NOt cOmplete thIs applIcatION.
/
/
5
Date of Birth
(MM/DD/YYYY)
6
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
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”: 7
8
9
10
11
Last Name Suffix (circle)
Jr. Sr. II
Address Where You Live (Legal Residence) DO NOT GIVE P.O. BOX. None
IV First Name
City
Middle Name/Initial
County of Legal Residence
State
Zip Code
Mailing Address If Different from Above
Apt/Lot/Unit
City
Country
State
Zip Code
Address Last Registered to Vote
Apt/Lot/Unit
City
County
State
Zip Code
Day Phone Number (optional)
Former Name if Making Name Change
Party Affiliation (Check only one)
13
Race/Ethnicity (Check only one)
14
Sex
15
Are You:
16
Apt/Lot/Unit
III
FL
12
reQUired
 New Registration  Address Change  Party Change  Name Change  Card Replacement  Signature Update
1
M
F
Democratic Party
Republican Party
American Indian/Alaskan Native
Do you need voting assistance at the polls?
Active Duty Military/Merchant Marine
minor party (print registered party name):
Asian/Pacific Islander
Yes
No
Black, not Hispanic
Hispanic
Are you interested in being a poll worker?
Dependent of Active Duty Military/Merchant Marine
Oath: I do solemnly swear (or affirm) that I will protect and defend the Constitution of the United States and the Constitution of the State of Florida, that 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.
NONE
White, not Hispanic
Yes
No
State or Country of Birth
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)
X
Date:
mAIL your
APPLICAtIoN
address your envelope to your county
supervisor of elections.
LAFAyEttE CouNty
Supervisor of Elections
PO Box 76
Mayo FL 32066
386-294-1261
PASCo CouNty
Supervisor of Elections
PO Box 300
Dade City FL 33526-0300
352-521-4302
LAkE CouNty
Supervisor of Elections
PO Box 457
Tavares FL 32778-0457
352-343-9734
PINELLAS CouNty
Supervisor of Elections
13001 Starkey Road
Largo FL 33773-1416
727-464-6108
ALACHuA CouNty
Supervisor of Elections
PO Box 1496
Gainesville FL 32602-1496
352-374-5252
FLAgLEr CouNty
Supervisor of Elections
PO Box 901
Bunnell FL 32110-0901
386-313-4170
LEE CouNty
Supervisor of Elections
PO Box 2545
Fort Myers FL 33902
239-533-VOTE (8683)
PoLk CouNty
Supervisor of Elections
PO Box 1460
Bartow FL 33831-1460
863-534-5888
BAkEr CouNty
Supervisor of Elections
PO Box 505
Macclenny FL 32063
904-259-6339
FrANkLIN CouNty
Supervisor of Elections
47 Ave. F
Apalachicola FL 32320
850-653-9520
LEoN CouNty
Supervisor of Elections
PO Box 7357
Tallahassee FL 32314-7357
850-606-VOTE (8683)
PutNAm CouNty
Supervisor of Elections
2509 Crill Ave., Suite 900
Palatka FL 32177
386-329-0224
BAy CouNty
Supervisor of Elections
205 Mosley Drive
Lynn Haven FL 32444
850-784-6100
gADSDEN CouNty
Supervisor of Elections
PO Box 186
Quincy FL 32353
850-627-9910
LEVy CouNty
Supervisor of Elections
421 S. Court St.
Bronson FL 32621
352-486-5163
SANtA roSA CouNty
Supervisor of Elections
6495 Caroline St., Suite F
Milton FL 32570-4592
850-983-1900
BrADForD CouNty
Supervisor of Elections
PO Box 58
Starke FL 32091
904-966-6266
gILCHrISt CouNty
Supervisor of Elections
112 S. Main St., Room 128
Trenton FL 32693
352-463-3194
LIBErty CouNty
Supervisor of Elections
PO Box 597
Bristol FL 32321
850-643-5226
SArASotA CouNty
Supervisor of Elections
PO Box 4194
Sarasota FL 34230-4194
941-861-8600
BrEVArD CouNty
Supervisor of Elections
PO Box 1119
Titusville FL 32781-1119
321-264-6740
gLADES CouNty
Supervisor of Elections
PO Box 668
Moore Haven FL 33471
863-946-6005
mADISoN CouNty
Supervisor of Elections
229 SW Pinckney St., Room 113
Madison FL 32340
850-973-6507
SEmINoLE CouNty
Supervisor of Elections
PO Box 1479
Sanford FL 32772-1479
407-585-VOTE (8683)
BroWArD CouNty
Supervisor of Elections
PO Box 029001
Fort Lauderdale FL 33302
954-357-7050
guLF CouNty
Supervisor of Elections
401 Long Ave.
Port St. Joe FL 32456-1707
850-229-6117
mANAtEE CouNty
Supervisor of Elections
PO Box 1000
Bradenton FL 34206
941-741-3823
St. JoHNS CouNty
Supervisor of Elections
4455 Ave. A, Suite 101
St. Augustine FL 32095
904-823-2238
CALHouN CouNty
Supervisor of Elections
20859 Central Ave. E., Room G10
Blountstown FL 32424
850-674-8568
HAmILtoN CouNty
Supervisor of Elections
1153 US Hwy. 41 NW, Suite 1
Jasper FL 32052
386-792-1426
mArIoN CouNty
Supervisor of Elections
PO Box 289
Ocala FL 34478-0289
352-620-3290
St. LuCIE CouNty
Supervisor of Elections
4132 Okeechobee Road
Fort Pierce FL 34947
772-462-1500
CHArLottE CouNty
Supervisor of Elections
PO Box 511229
Punta Gorda FL 33951-1229
941-637-2232
HArDEE CouNty
Supervisor of Elections
311 N. 6th Ave.
Wauchula FL 33873
863-773-6061
mArtIN CouNty
Supervisor of Elections
PO Box 1257
Stuart FL 34995
772-288-5637
SumtEr CouNty
Supervisor of Elections
900 N. Main St.
Bushnell FL 33513
352-793-0230
CItruS CouNty
Supervisor of Elections
120 N. Apopka Ave.
Inverness FL 34450
352-341-6740
HENDry CouNty
Supervisor of Elections
PO Box 174
LaBelle FL 33975
863-675-5230
mIAmI-DADE CouNty
Supervisor of Elections
PO Box 521550
Miami FL 33152-1550
305-499-VOTE (8683)
SuWANNEE CouNty
Supervisor of Elections
220 Pine Ave. SW
Live Oak FL 32064
386-362-2616
CLAy CouNty
Supervisor of Elections
PO Box 337
Green Cove Springs FL 32043-0337
904-284-6350
HErNANDo CouNty
Supervisor of Elections
20 N. Main St., Room 165
Brooksville FL 34601
352-754-4125
moNroE CouNty
Supervisor of Elections
530 Whitehead St., Suite 101
Key West FL 33040-6577
305-292-3416
tAyLor CouNty
Supervisor of Elections
PO Box 1060
Perry FL 32348
850-838-3515
CoLLIEr CouNty
Supervisor of Elections
3301 Tamiami Trail E.,
Rev. Dr. MLK Jr. Bldg.
Naples FL 34112
239-252-8450
HIgHLANDS CouNty
Supervisor of Elections
PO Drawer 3448
Sebring FL 33871
863-402-6655
NASSAu CouNty
Supervisor of Elections
96135 Nassau Place, Suite 3
Yulee FL 32097
904-491-7500
uNIoN CouNty
Supervisor of Elections
55 W. Main St., Room 106
Lake Butler FL 32054
386-496-2236
HILLSBorougH CouNty
Supervisor of Elections
601 E. Kennedy Blvd., 16th Floor
Tampa FL 33602
813-272-5850
okALooSA CouNty
Supervisor of Elections
302 Wilson St. N., Suite 102
Crestview FL 32536-3440
850-689-5600
VoLuSIA CouNty
Supervisor of Elections
125 W. New York Ave.
DeLand FL 32720-4208
386-736-5930
HoLmES CouNty
Supervisor of Elections
201 N. Oklahoma St., Suite 102
Bonifay FL 32425
850-547-1107
okEECHoBEE CouNty
Supervisor of Elections
304 NW 2nd St., Room 101
Okeechobee FL 34972
863-763-4014
WAkuLLA CouNty
Supervisor of Elections
PO Box 305
Crawfordville FL 32326-0305
850-926-7575
INDIAN rIVEr CouNty
Supervisor of Elections
4375 43rd Ave., Unit 101
Vero Beach FL 32967
772-226-3440
orANgE CouNty
Supervisor of Elections
PO Box 562001
Orlando FL 32856
407-836-2070
WALtoN CouNty
Supervisor of Elections
571 E. Nelson Ave. (US Hwy. 90)
DeFuniak Springs FL 32433
850-892-8112
JACkSoN CouNty
Supervisor of Elections
PO Box 6046
Marianna FL 32447
850-482-9652
oSCEoLA CouNty
Supervisor of Elections
2509 E. Irlo Bronson Memorial Hwy.
Kissimmee FL 34744
407-742-6000
WASHINgtoN CouNty
Supervisor of Elections
1331 South Blvd., Suite 900
Chipley FL 32428
850-638-6230
JEFFErSoN CouNty
Supervisor of Elections
380 W. Dogwood St.
Monticello FL 32344
850-997-3348
PALm BEACH CouNty
Supervisor of Elections
PO Box 22309
West Palm Beach FL 33416
561-656-6200
CoLumBIA CouNty
Supervisor of Elections
971 W. Duval St., Suite 102
Lake City FL 32055-3737
386-758-1026
DESoto CouNty
Supervisor of Elections
PO Box 89
Arcadia FL 34265
863-993-4871
DIXIE CouNty
Supervisor of Elections
PO Box 2057
Cross City FL 32628
352-498-1216
DuVAL CouNty
Supervisor of Elections
105 E. Monroe St.
Jacksonville FL 32202
904-630-1414
ESCAmBIA CouNty
Supervisor of Elections
PO Box 12601
Pensacola FL 32591-2601
850-595-3900
SPECIAL
IDENtIFICAtIoN
rEQuIrEmENtS
If you are registering by mail, you have never voted
in Florida, and you have not been issued a Florida
driver’s license, Florida identification card, or Social
Security number, you will be required to provide
additional identification prior to voting the first
time. To ensure that you will not have problems
when you go to vote, you should provide a copy of
the required identification listed below at the time
you mail your voter registration application.
You may provide a copy of one of
the following photo identifications
(ID) that includes your name and
picture:
• U.S. Passport
• Employee Badge or ID
• Buyers Club ID • Debit/Credit Card
• Military ID
• Student ID
• Retirement Center ID
• Neighborhood Association ID
• Public Assistance ID
Or, you may provide a copy of one
of the following documents that
contains your name and current
residence address:
• Bank Statement
• Paycheck
• Government Check
• Utility Bill
• Other Government Document
Or, if you are one of the following
persons, you are exempt from
having to provide a copy of an ID at
this time. These exemptions are:
• Persons 65 years of age or older
• Persons with a temporary or permanent
physical disability
• Members of the active uniformed service
or merchant marine who, by reason of such
active duty, are absent from the county
• Spouse or dependent of an active uniformed
service member or merchant marine who,
by reason of the active duty or service of the
member, is absent from the county
• Persons currently residing outside the U.S.
who are eligible to vote in Florida
DO NOT SEND ORIGINAL
IDENTIFICATION DOCUMENTS TO
THE SUPERVISOR OF ELECTIONS.