STATE OF NORTH CAROLINA VOTER REGISTRATION APPLICATION

You May Use This Form If You Are A North CarolinaResident To:

Change the name and/or address of your currentregistration

If you are not a resident of North Carolina, you candownload the National Voter Registration Form atwww.eac.govDeadline! In Order to Vote in an Election, ThisForm Must Be:

Register to vote in your county of residence

Postmarked, hand-delivered, or faxed to the local boardof elections office no later than 5:00 P.M. on the 25thday before the election. If faxed, the original must bereceived within 5 days.

Declare a party affiliation or change party affiliation

Qualifications:

You must be 18 years of age by General Election Day.

If convicted of a felony, you may register to vote only afteryou have completed your sentence, including probation orparole. Once you have done that, North Carolinaautomatically restores your citizenship rights including yourright to vote.

You must be a US citizen by birth or naturalization.

If you have questions, please call the State Board ofElections at (866) 522-4723 or visit their web site atwww.sboe.state.nc.us.

If you are registering by mail, and cannot provide a valid ID number in Section 2, you must submit a copy of one ofthe following forms of current and valid identification with this application. If you do not provide this information,you will be required to provide one of these forms of ID to an election official when you vote for the first time in thiscounty.

A current and valid photo identification

A current utility bill, or bank statement, government check or paycheck, or a government document thatshows your name and address as it appears on this application.

The location where you received this form will remain confidential and will be used only for registrationadministration purposes.

You must register with a party to vote in that party's primary unless that party allows unaffiliated voters to vote in itsprimary. In Section 7, if you indicate a political party that is not qualified or indicate no choice you will be registeredas "Unaffiliated."

If you decline to register to vote, the fact that you so declined will remain confidential.

To be eligible to vote in the county you are registering in, you must have resided in that county for at least 30 daysbefore the day of the election.

PLEASE READRequirements:

To Mail - Place this completed and signed form in an envelope addressed to your local County Board o f Electionsoffice. Be sure to affix the proper USPS postage stamp.

For a list of the Local County Board of Elections Offices, visit the North Carolina State Board of Elections website at:

You may register to vote only in the county where you reside.

www.sboe.state.nc.us

North Carolina Voter Registration Application/Update FormPrint Information and Sign Below

I Attest, Under Penalty of Perjury, that: (Answer YES or NO to the following questions.)YES NO

If you checked "NO" in response to any of these questions, DO NOT COMPLETE THIS FORM

Section 1Full legalname andbirth date

Section 2PersonalIdentificationNumber(Required)

Section 3ResidenceAddress(Required)

Section 4MailingAddress

Section 5 Section 6 Race/Ethnicity Section 7 Political Party AffiliationGender

Section 8Name andaddress usedfor your lastvoterregistrationif applicable

Signature DateI HAVE READ AND UNDERSTAND THE CONTENTS OF THIS FORM

WARNING: If you sign this card and know it to be false, you can be convicted of a Class I felony

To Mail - Place this completed and signed form in an envelope addressed to your local County Board of Elections office. Besure to affix the proper USPS postage stamp.

Do you have a NC driver's license or NC identification cardissued by DMV? If yes, provide the number.If you do not have a DMV-issued card, do you have a U.S.-issued Social Security Number? If yes, provide last 4 digits.Have you been assigned a NC State Voter RegistrationNumber? If yes, provide unless you provided one of thenumbers above.

NC Driver License or Identification Number

Social Security Number (Last Four Digits)

NC State Voter Registration Number

Last Name (Required) First Name (Required)

Middle Name (Required) Date of Birth - MM/DD/YYYY

Street Address where you live - No P.O. Boxes or Rural Roads Apt/Unit

City

County

Phone (Optional)

State ZIP CodeHave you lived here for 30 days or more?If no, date moved __________________

Map/DiagramIf you do not have a street address, draw a map of where youreside. Please include roads and landmarks.

N C

Address where you get your mail (If different from your residence address.) Apt/Unit

City State ZIP Code

Other

Last Name used in Previous Registration First Name

Previous Address

Previous City

State ZIP Code

Previous County

06w

I am a United States citizen.I am 18 years old, or will be by general election day.I have been a resident at this address for 30 days or more. If less than 30 days, I moved here on ____________(date).I will not vote in any other county or state after submission of this form. If I am registered elsewhere, I am canceling thatregistration at this time.

I have not been convicted of a felony; or if I have been convicted of a felony, my rights of citizenship have been restored.

Jr.

IVII

IIISr

Male

Female

Yes No

Yes No

Yes No

XX X X X

YesNo

Hispanic/Latino

American Indian/Alaska Native

Asian

White

Black/AfricanAmericanTwo or More

Other

Democratic Republican Unaffliated

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Place of Birth (Required)