Harris Votes - Voter Registration

These Questions Must Be Completed Before Proceeding (Check one)

New Application

Change of Address, Name, or Other Information

Request for a Replacement Card

Are you interested in serving as an election worker?

Yes

Last Name (Include suffix (Jr, Sr, III)):

First Name:

Middle Name (if any):

Former Name (if any):

Residence Address: Street Address and Apartment Number. If none, describe where you live. (Do not include P.O. Box, Rural Rt. or Business Address)

County:

Address:

City:

State:

Zip:

Mailing Address: Street Address and Apartment Number. (If mail cannot be delivered to your residence address)

Address:

City:

State:

Zip:

City and County of Former Residence in Texas:

Date of Birth (mm/dd/yyyy):

Gender (optional):

Telephone Number, Include Area Code (Optional):

Texas Driver's License No. or Texas Personal I.D. No. (Issued by the Department of Public Safety)

If no Texas Driver's License or Personal Identification, give last 4 digits of your Social Security Number

xxx-xx-

I have not been issued a Texas Driver's License/Personal Identification Number or Social Security Number

I understand that giving false information to procure a voter registration is perjury, and a crime under state and federal law. Conviction of this crime may result in imprisonment up to one year in jail, a fine up to $4,000, or both. Please read all three statements to affirm before signing.

I am a resident of this county and a U.S. Citizen.
I have not been finally convicted of a felony, or if a felon, I have completed all of my punishment including any term of incarceration, parole, supervision, period of probation, or I have been pardoned; and
I have not been determined by a final judgment of a court exercising probate jurisdiction to be totally mentally incapacitated or partially mentally incapacitated without the right to vote.

Date:

Please verify that your data is correct before you "Submit"

Hitting the 'Submit' button will load your information into the proper form for you to print, sign, and mail. Do not mail this screen.