"Hawaii Voter Registration & Permanent Absentee Application" - Hawaii

The Hawaii Office of Elections has released this version of the "Hawaii Voter Registration & Permanent Absentee Application" on January 1, 2017.

This form may be used by all Hawaii residents: download the printable PDF by clicking the link below and use it according to the applicable legal guidelines.

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Download "Hawaii Voter Registration & Permanent Absentee Application" - Hawaii

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First Time Voters Mailing this
Language Assistance
Application
若想獲得電子檔的翻譯材料,或者需要協助填表事
宜,請聯繫 選舉辦公室 (Office of Elections).
If you are 1) registering to vote for the first time in
the State of Hawaii; 2) mailing this application; and
Para kadagiti naipatarus a materiales a mainaig
3) do not have a HI Driver License, HI State ID, or
iti eleksion wenno tulong iti lengguahe tapno
last 4-digits of a Social Security Number, you are
makompletoyo daytoy nga aplikasion, awagan ti
required to provide proof of identification.
Opisina Dagiti Eleksion (Office of Elections).
Proof of identification includes a copy of:
Voter
A current and valid photo identification; or
Contact Us
A current utility bill, bank statement,
government check, paycheck, or other
For voter registration and absentee voting
government document that shows your name
information, contact your
Clerk’s
Office.
Registration
and address.
County of Hawaii
..............................(808) 961-8277
County of Maui
..................................(808) 270-7749
+
Submitting Application
County of Kauai
................................(808) 241-4800
Mail or deliver
your application to your Clerk’s
City & County of Honolulu
...............(808) 768-3800
Office at the address below.
Permanent
For additional voting information, contact the
Office of
Elections.
County of Hawaii
County of Kauai
25 Aupuni St., Rm. 1502
4386 Rice St., Rm. 101
(808) 453-VOTE (8683)
Absentee
Hilo, HI 96720
Lihue, HI 96766
Toll Free: 1-800-442-VOTE (8683)
County of Maui
City & County of Honolulu
TTY: (808) 453-6150
200 S. High St., Rm. 708
530 S. King St., Rm. 100
Toll Free TTY: 1-800-345-5915
Application
Wailuku, HI 96793
Honolulu, HI 96813
Email: elections@hawaii.gov
Website: www.elections.hawaii.gov
Deadline to Submit Application
Registering to Vote:
No later than 30 days prior to
the election.
Requesting a Permanent Absentee Ballot:
No
later than 7 days prior to the election.
Rev. 2017
English
First Time Voters Mailing this
Language Assistance
Application
若想獲得電子檔的翻譯材料,或者需要協助填表事
宜,請聯繫 選舉辦公室 (Office of Elections).
If you are 1) registering to vote for the first time in
the State of Hawaii; 2) mailing this application; and
Para kadagiti naipatarus a materiales a mainaig
3) do not have a HI Driver License, HI State ID, or
iti eleksion wenno tulong iti lengguahe tapno
last 4-digits of a Social Security Number, you are
makompletoyo daytoy nga aplikasion, awagan ti
required to provide proof of identification.
Opisina Dagiti Eleksion (Office of Elections).
Proof of identification includes a copy of:
Voter
A current and valid photo identification; or
Contact Us
A current utility bill, bank statement,
government check, paycheck, or other
For voter registration and absentee voting
government document that shows your name
information, contact your
Clerk’s
Office.
Registration
and address.
County of Hawaii
..............................(808) 961-8277
County of Maui
..................................(808) 270-7749
+
Submitting Application
County of Kauai
................................(808) 241-4800
Mail or deliver
your application to your Clerk’s
City & County of Honolulu
...............(808) 768-3800
Office at the address below.
Permanent
For additional voting information, contact the
Office of
Elections.
County of Hawaii
County of Kauai
25 Aupuni St., Rm. 1502
4386 Rice St., Rm. 101
(808) 453-VOTE (8683)
Absentee
Hilo, HI 96720
Lihue, HI 96766
Toll Free: 1-800-442-VOTE (8683)
County of Maui
City & County of Honolulu
TTY: (808) 453-6150
200 S. High St., Rm. 708
530 S. King St., Rm. 100
Toll Free TTY: 1-800-345-5915
Application
Wailuku, HI 96793
Honolulu, HI 96813
Email: elections@hawaii.gov
Website: www.elections.hawaii.gov
Deadline to Submit Application
Registering to Vote:
No later than 30 days prior to
the election.
Requesting a Permanent Absentee Ballot:
No
later than 7 days prior to the election.
Rev. 2017
English
Hawaii Voter Registration &
This application can be used for:
Permanent Absentee Application
• First time registration
• Request to vote by mail permanently
Please print clearly in black ink.
• Name change
• Address change
Yes
No
Are you a citizen of the United States of America?
The residence stated in this affidavit is not simply
1
Yes
No
Are you at least 16 years of age? (Must be 18 to vote)
1
because of my presence in the State, but was acquired
Yes
No
Are you a resident of the State of Hawaii?
1
with the intent to make Hawaii my legal residence with
all the accompanying obligations therein.
If you answered “No” to any of the above, DO NOT complete this form.
Last Name
First Name
M.I.
Suffix (Jr., II)
2
HI Driver License or HI State ID Number
I do not have a HI Driver License or HI State ID.
If you do not have either, complete box 3b.
Provide the last 4-digits of your Social Security Number.
3
3b
I do not have a HI Driver License, HI State ID, or SSN.
Date of Birth
Phone Number
Email
4
Residence Address (P.O. Box, R.R., S.R. are not acceptable)
Apt. Number
City
Zip Code
Mailing Address in Hawaii
Same as Residence Address
Apt. Number
City
Zip Code
5
If your residence does not have a street address, describe the location (cross streets, landmarks).
Are you registered to vote in another state?
Last Registered Address, County, State, and Zip Code
6
6b
Yes. I hereby authorize cancellation of my previous registration.
Complete box 6b.
Would you like to permanently receive absentee ballots by mail?
Yes. I request to permanently receive absentee ballots at the mailing address associated with my voter registration.
7
I understand that my permanent absentee voter status will be terminated if: 1) I request termination in writing; 2) I die, lose voting rights, register in another
jurisdiction, or am otherwise disqualified from voting; 3) my absentee ballot, voter notification postcard, or any other election mail is returned to the clerk as
undeliverable for any reason; or 4) I do not return my ballot by 6:00 PM on election day in both the primary and general election of an election year. If so, I understand
that I must reapply for permanent absentee status.
Warning: Any person who knowingly furnishes false information may be guilty of a Class C felony.
I hereby swear (or affirm) that all information furnished on this application is true and correct.
Date
SIGN
HERE
8
If you are unable to sign, mark the signature line and have a witness provide signature, address, and phone number.
ID Number
Location Code
Document Number
Office Use
Only
Notice: The identity of the voter registration agency through which any particular voter was registered shall not be publicly disclosed. A person’s declination to register to vote is
also confidential and is used for voter registration purposes only (National Voter Registration Act of 1993).
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