Form VRFM006 "Voter Registration File Request" - Delaware

Form VRFM006 is a Delaware Department of Elections form also known as the "Voter Registration File Request". The latest edition of the form was released in February 13, 2018 and is available for digital filing.

Download an up-to-date Form VRFM006 in PDF-format down below or look it up on the Delaware Department of Elections Forms website.

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Download Form VRFM006 "Voter Registration File Request" - Delaware

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FOR OFFICE USE ONLY 
State of Delaware
 
Amount Paid: __________    Rec. By: ____________      
Department of Elections
 
CFID #: ________________  IRTS #: _____________ 
Voter Registration File Request
 
1. Requestor
(Must be a Delaware Resident; Delaware is your home)
Full Name:
Residential Address:
Phone:
Email:
 
2. Requestor Type
(Select one)
Major/Minor Political Party
Candidate
Public
General Assembly; State Agencies; County or Local Government
 
3. Organization Information
(Required when requesting on behalf of an organization)
Name of Entity:
Address:
Phone:
Company Contact:
 
4. Delivery Information
(Select one)
Pick up
Ship to:
 
5. Payment Information
(Select one. Cost per request is $25, plus $3 for shipping, if applicable.)
 Check#_________
 Cash
(Payable to State of Delaware)
(In person submission only)
 Money Order #________________
 No Cost
 
(See Title 15,
Chapter 3, §304(e))
 
6. Ordering Notes
(Read Notes)
 Allow up to 10 business days upon receipt of request  Limit of 1 active request at a time
 Delaware Code, Title 15, Chapter 3, §304(h): Files and lists provided to members of the General Assembly and
State agencies or county or local governments pursuant to subsection (f) of this section shall include voter names,
addresses, political party affiliation, voting history, telephone numbers, and dates of birth. Files and lists provided
to major and minor political parties pursuant to subsections (a) through (d) of this section and to candidates for
elective office pursuant to subsection (e) of this section shall be limited to voter names, addresses, political party
affiliations, voting history, legislative district information, telephone numbers, and years of birth. Files and lists
provided to the public shall be limited to voter names, addresses, political party affiliations, voting history, legislative
district information, and years of birth.
 
7. Affirmation
(Read Statement and Sign Oath)
I swear or affirm, under penalty of perjury, that:
 I am a citizen of Delaware. Delaware is my home.
 The Voter Registration information and any accompanying documents received as part of this request
will not be used for commercial solicitation or for any other purpose not related to the electoral process,
or make the information available to the public or third parties or publish or republish the information in
a way that allows it to be used in that manner.
 The information on this form is true, accurate, and complete to the best of my knowledge. I understand
that a material misstatement of fact in completion of this document may constitute grounds for
conviction of perjury.
X
Sign here
Today’s date
(MM/DD/YYYY)
 
https://ivote.de.gov
State Election Commissioner
New Castle County Office
Kent County Office
Sussex County Office
905 S Governors Ave Ste 170
Carvel State Office Bldg
100 Enterprise Pl Ste 5
119 N Race St
Dover DE 19904
820 N French St STE 400
Dover DE 19904
PO Box 457
Phone: (302) 739-4277
Wilmington DE 19801
Phone: (302) 739-4498
Georgetown DE 19947
Phone: (302) 577-3464
Phone: (302) 856-5367
VRFM006 v2.0 2/13/2018 
 
FOR OFFICE USE ONLY 
State of Delaware
 
Amount Paid: __________    Rec. By: ____________      
Department of Elections
 
CFID #: ________________  IRTS #: _____________ 
Voter Registration File Request
 
1. Requestor
(Must be a Delaware Resident; Delaware is your home)
Full Name:
Residential Address:
Phone:
Email:
 
2. Requestor Type
(Select one)
Major/Minor Political Party
Candidate
Public
General Assembly; State Agencies; County or Local Government
 
3. Organization Information
(Required when requesting on behalf of an organization)
Name of Entity:
Address:
Phone:
Company Contact:
 
4. Delivery Information
(Select one)
Pick up
Ship to:
 
5. Payment Information
(Select one. Cost per request is $25, plus $3 for shipping, if applicable.)
 Check#_________
 Cash
(Payable to State of Delaware)
(In person submission only)
 Money Order #________________
 No Cost
 
(See Title 15,
Chapter 3, §304(e))
 
6. Ordering Notes
(Read Notes)
 Allow up to 10 business days upon receipt of request  Limit of 1 active request at a time
 Delaware Code, Title 15, Chapter 3, §304(h): Files and lists provided to members of the General Assembly and
State agencies or county or local governments pursuant to subsection (f) of this section shall include voter names,
addresses, political party affiliation, voting history, telephone numbers, and dates of birth. Files and lists provided
to major and minor political parties pursuant to subsections (a) through (d) of this section and to candidates for
elective office pursuant to subsection (e) of this section shall be limited to voter names, addresses, political party
affiliations, voting history, legislative district information, telephone numbers, and years of birth. Files and lists
provided to the public shall be limited to voter names, addresses, political party affiliations, voting history, legislative
district information, and years of birth.
 
7. Affirmation
(Read Statement and Sign Oath)
I swear or affirm, under penalty of perjury, that:
 I am a citizen of Delaware. Delaware is my home.
 The Voter Registration information and any accompanying documents received as part of this request
will not be used for commercial solicitation or for any other purpose not related to the electoral process,
or make the information available to the public or third parties or publish or republish the information in
a way that allows it to be used in that manner.
 The information on this form is true, accurate, and complete to the best of my knowledge. I understand
that a material misstatement of fact in completion of this document may constitute grounds for
conviction of perjury.
X
Sign here
Today’s date
(MM/DD/YYYY)
 
https://ivote.de.gov
State Election Commissioner
New Castle County Office
Kent County Office
Sussex County Office
905 S Governors Ave Ste 170
Carvel State Office Bldg
100 Enterprise Pl Ste 5
119 N Race St
Dover DE 19904
820 N French St STE 400
Dover DE 19904
PO Box 457
Phone: (302) 739-4277
Wilmington DE 19801
Phone: (302) 739-4498
Georgetown DE 19947
Phone: (302) 577-3464
Phone: (302) 856-5367
VRFM006 v2.0 2/13/2018 
 
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