State Of Utah Mail In Voter Registration Form
State of Utah
Mail-in Voter Registration Form
Effective May 12, 2009, all voters must present identification at their polling place. Absentee voters casting a ballot for the
first time in Utah must include a copy of their identification when returning their absentee ballot.
Voter Instructions
You may use this form to:
● Register to vote in Utah
● Change your name or address on your voter registration record
● Affiliate with a party or change your party affiliation
To register to vote in Utah, you must:
● Be a citizen of the United States
● Have resided in Utah at least 30 days immediately before the next election
● Be at least 18 years old on or before the next election
Mail-in registration instructions:
● Complete all required information
● If you have registered to vote with a different name or address, complete the change of information section
● One of the following is required: a Driver License number, a State Identification number, or the last four digits of your Social
Security number. If you do not have a Driver License or a State Identification card, please write “None” in the space designated
for a Driver License or State Identification and fill in your Social Security number
● Read the voter declaration and citizenship affidavit and sign and date below
● Mail the form to your county clerk's office (addresses are on the back of this form)
Deadline for submitting this form
This form must be postmarked at least 30 days before an election or be presented in person to the county clerk at least 15 days before an election for you
to be eligible to vote in that election. If you register less than 30 days before an election, you may only vote on Election Day and not during early voting
For more information
If you need more information, contact your county clerk at the number listed on the back of this form, or the Lieutenant Governor's Office at
elections.utah.gov or 1-800-995-VOTE
NOTICE: In order to be allowed to vote you must present valid voter identification to the poll worker before voting, which must be a valid form of photo
identification that shows your name and photograph, or, (2) two different forms of identification that show your name and current address
Reason(s) for completing this form (optional)
Are you a citizen of the United States?
Yes No
New Registration Party Affiliation Change
Will you be at least 18 years on or before election day?
Yes No
Address Change
Name
Change
Qualifications: If you check no in response to either of these questions do not complete this form
Last Name
First Name
Middle Name
Name at Birth (if different than above)
Physical Address (required, principal place of residence, no P.O. Box)
County
City
State
Zip Code
Mailing Address (if different from Physical)
County
City
State
Zip Code
Phone Number (optional)
Date of Birth (required, month/day/year)
Place of Birth (required, state or country)
I am a person with a disability
(optional) Yes No
Place of Naturalization (if applicable)
Date
Political Party: (optional) Constitution Democratic Libertarian Republican
Unaffiliated (no party preference) Other (please specify) ______________________
Driver License number or State Identification number
State Issued
Read and Sign below
Voter Declaration: I do swear (or affirm), subject to penalty of law for false statements,
that the information contained in this form is true and that I am a citizen of the United
States and a resident of the State of Utah, residing at the above address. I will be at least
Last Four Digits of Social Security Number
18 years old on or before the next election and I will have resided in Utah for 30 days
immediately before the next election. I am not a convicted felon currently incarcerated for
commission of a felony.
If previously registered and/or changing personal information, also fill out
Citizenship Affidavit: I hereby swear and affirm, under penalties
this section.
for voting fraud set forth below in Utah Code Section 20A-2-401,
that I am a citizen and that to the best of my knowledge and belief
Name on Previous Registration
the information above is true and correct.
Address on Previous Registration
City
State Zip
Signature
Date (Month/day/year)
(The above signature applies to the Voter Declaration and the Citizenship Affidavit)
In accordance with section 20A-2-401, the penalty for willfully causing, procuring, or
Office use only:
allowing yourself to be registered to vote if you know you are not entitled to vote is up to
Type of ID _________________________________________
Form Type: By Mail
Voting precinct ____________ Voting ID # _______________
one year in jail and a fine of up to $2,500.
________________________________________
PLACE
FIRST
CLASS
________________________________________
POSTAGE
HERE
________________________________________
Please write your county election office address below.
___________________________________________________________
___________________________________________________________
___________________________________________________________
For more voter registration information
Contact your county clerk at the address or telephone number below
BEAVER County Clerk
DUCHESNE County Clerk
KANE County Clerk
SAN JUAN County Clerk
UTAH County Clerk
105 East Center
734 North Center Street
76 North Main
117 South Main
100 E. Center Rm. 3100
PO Box 392
PO Box 270
Kanab, UT 84741
PO Box 338
Provo, UT 84606
Beaver, UT 84713
Duchesne, UT 84021
(435) 644-2458
Monticello, UT 84535
(801) 851-8128
(435) 438-6463
(435) 738-1100
(435) 587-3223
MILLARD County Clerk
WASATCH County Clerk
BOX ELDER County C lerk
EMERY County Clerk
765 South Hwy 99, Ste. 6
SANPETE County Clerk
25 North Main
01 South Main St
75 East Main
Fillmore, UT 84631
160 North Main
Heber City, UT 84032
Brigham City, UT 8430
2
PO Box 907
(435) 743-6223
PO Box 100
(435) 654-3211
(435) 734-3391
Castle Dale, UT 84513
Manti, UT 84642
(435) 381-5106
MORGAN County Clerk
(435) 835-2131
WASHINGTON County Clerk
CACHE County Clerk
48 West Young St.
197 East Tabernacle St.
179 North Main S
t., Ste 102
GARFIELD County Clerk
PO Box 886
SEVIER County Clerk
St. George, UT 84770
Logan, UT 84321
55 South Main
Morgan, UT 84050
250 North Main
(435) 634-5712
(435) 755-1460
PO Box 77
(801) 845-4011
PO Box 607
Panguitch, UT 84759
Richfield, UT 84701
WAYNE County Clerk
CARBON Count
y Clerk
(435) 646-8826
PIUTE County Clerk
(435) 893-0401
18 South Main
120 East Main St.
550 North Main
PO Box 189
Price, UT 84501
GRAND County Clerk
PO Box 99
SUMMIT County Clerk
Loa, UT 84747
(435) 636-3224
125 East Center
Junction, UT 84740
60 North Main
(435) 836-1300
Moab, UT 84532
(435) 577-2840
PO Box 128
DAGGETT County Clerk
(435) 259-1321
Coalville, UT 84017
WEBER County Clerk
95 North 1st West
RICH County Clerk
(435) 336-3204
2380 Washington Blvd.
PO Box 219
IRON County Clerk
20 South Main
Suite 320
Manila, UT 84046
68 South 100 East
PO Box 218
TOOELE County Clerk
Ogden, UT 84401
(435) 784-3154
PO Box 429
Randolph, UT 84064
47 South Main
(801) 399-8400
Parowan, UT 84761
(435) 793-2415
Tooele, UT 84074
DAVIS County Clerk
(435) 477-8340
(435) 843-3140
28 East State St.
SALT LAKE County Clerk
PO Box 618
JUAB County Clerk
Elections Division
UINTAH County Clerk
Farmington, UT 84025
160 North Main St.
2001 S. State St. #S1100
147 East Main
(801) 451-3589
Nephi, UT 84648
Salt Lake City, UT 84190
Vernal, UT 84078
(435) 623-3410
(801) 468-3427
(435) 781-5361
