State Codes and Statutes

Statutes > Vermont > Title-17 > Chapter-43 > 2145

§ 2145. Application forms

(a) The voter registration application shall be in the form approved by the federal election commission or by the secretary of state. The application form approved by the secretary shall include:

(1) A place for the applicant to swear or affirm, by checking the appropriate box, that he or she meets all voter eligibility requirements set forth in section 2121 of this title and a place for the signature of the applicant affirming, under penalty of perjury, that all information submitted by the applicant is accurate and truthful. The affirmation shall include the following information:

(A) The applicant's place and date of birth.

(B) The applicant's town of legal residence.

(C) The applicant's street address or a description of the physical location of the applicant's residence. The description must contain sufficient information so that the town clerk can determine whether the applicant is a resident of the town.

(D)(i) if the applicant has been issued a current and valid driver's license or nondriver's identification, the applicant's driver's license number or nondriver's identification number; or

(ii) if the applicant does not possess a driver's license number, the last four digits of the applicant's Social Security number; or

(iii) if the applicant does not possess a Social Security number, the town clerk shall contact the secretary of state and the secretary shall assign a unique identifier for the applicant.

(2) The voter's oath and a space for a person administering the voter's oath to another to execute the written notification required by section 2124 of this title.

(3) Space for the town clerk to document action on the application.

(4) The following statements:

"If you were provided with this form when you applied for, or renewed, a motor vehicle driver's license or were provided with this application form by a voter registration agency, you may decline to register. If you decline to register, your failure to register will remain confidential and will be used only for voter registration purposes."

"If you are submitting this application in connection with a motor vehicle driver's license application, or renewal, or through a voter registration agency, the office through which you submitted this application will remain confidential and will be used only for voter registration purposes."

(5) The following statement on applications provided by the department of motor vehicles: "Keep this receipt and take it to the polls when you go to vote. This is proof you submitted an application before the deadline for registration."

(b) [Deleted.]

(c) A board of civil authority or town clerk may not require a person to complete any form other than that approved under subsection (a) of this section or section 2145a of this title; nor may the board of civil authority require all applicants or any particular class or group of applicants to appear personally before a meeting of the board or routinely or as a matter of policy require applicants to submit additional information to verify or otherwise support the information contained in the application form.

(d) When the board of civil authority acts on an application to add a name to the checklist, it shall notify the applicant by returning one copy of the completed application to the applicant and shall send one copy of the completed application to the town in which the applicant was last registered to vote, whether within or without the state of Vermont, before adding the applicant's name and mailing address to the checklist. The original application shall be filed in the office of the town clerk.

(e) The secretary of state shall provide each town clerk and voter registration agency with a sufficient number of forms at state expense.

(f) A person who makes a false statement in completing a voter registration application form or the voter registration portion of an application for a motor vehicle driver's license knowing the statement to be false shall be subject to the penalties of perjury as provided in 13 V.S.A. § 2901.

(g) A voter who moves from one address in a town in which that voter is registered to another address in the same town, or whose name has been changed, shall not be required to reapply as provided in this section, but shall notify the town clerk of his or her new name or address, unless such information has been provided to the department of motor vehicles or a voter registration agency, so that the voter's name may be changed or transferred, if necessary, to the proper subdivision of the checklist. The voter registration application form may be used to notify the clerk or the board that the voter has changed his or her name or address. (Added 1977, No. 269 (Adj. Sess.), § 1; amended 1981, No. 239 (Adj. Sess.), § 10; 1997, No. 47, § 4; 2001, No. 7, § 1, eff. Jan. 1, 2002; 2003, No. 59, § 4.)

State Codes and Statutes

Statutes > Vermont > Title-17 > Chapter-43 > 2145

§ 2145. Application forms

(a) The voter registration application shall be in the form approved by the federal election commission or by the secretary of state. The application form approved by the secretary shall include:

(1) A place for the applicant to swear or affirm, by checking the appropriate box, that he or she meets all voter eligibility requirements set forth in section 2121 of this title and a place for the signature of the applicant affirming, under penalty of perjury, that all information submitted by the applicant is accurate and truthful. The affirmation shall include the following information:

(A) The applicant's place and date of birth.

(B) The applicant's town of legal residence.

(C) The applicant's street address or a description of the physical location of the applicant's residence. The description must contain sufficient information so that the town clerk can determine whether the applicant is a resident of the town.

(D)(i) if the applicant has been issued a current and valid driver's license or nondriver's identification, the applicant's driver's license number or nondriver's identification number; or

(ii) if the applicant does not possess a driver's license number, the last four digits of the applicant's Social Security number; or

(iii) if the applicant does not possess a Social Security number, the town clerk shall contact the secretary of state and the secretary shall assign a unique identifier for the applicant.

(2) The voter's oath and a space for a person administering the voter's oath to another to execute the written notification required by section 2124 of this title.

(3) Space for the town clerk to document action on the application.

(4) The following statements:

"If you were provided with this form when you applied for, or renewed, a motor vehicle driver's license or were provided with this application form by a voter registration agency, you may decline to register. If you decline to register, your failure to register will remain confidential and will be used only for voter registration purposes."

"If you are submitting this application in connection with a motor vehicle driver's license application, or renewal, or through a voter registration agency, the office through which you submitted this application will remain confidential and will be used only for voter registration purposes."

(5) The following statement on applications provided by the department of motor vehicles: "Keep this receipt and take it to the polls when you go to vote. This is proof you submitted an application before the deadline for registration."

(b) [Deleted.]

(c) A board of civil authority or town clerk may not require a person to complete any form other than that approved under subsection (a) of this section or section 2145a of this title; nor may the board of civil authority require all applicants or any particular class or group of applicants to appear personally before a meeting of the board or routinely or as a matter of policy require applicants to submit additional information to verify or otherwise support the information contained in the application form.

(d) When the board of civil authority acts on an application to add a name to the checklist, it shall notify the applicant by returning one copy of the completed application to the applicant and shall send one copy of the completed application to the town in which the applicant was last registered to vote, whether within or without the state of Vermont, before adding the applicant's name and mailing address to the checklist. The original application shall be filed in the office of the town clerk.

(e) The secretary of state shall provide each town clerk and voter registration agency with a sufficient number of forms at state expense.

(f) A person who makes a false statement in completing a voter registration application form or the voter registration portion of an application for a motor vehicle driver's license knowing the statement to be false shall be subject to the penalties of perjury as provided in 13 V.S.A. § 2901.

(g) A voter who moves from one address in a town in which that voter is registered to another address in the same town, or whose name has been changed, shall not be required to reapply as provided in this section, but shall notify the town clerk of his or her new name or address, unless such information has been provided to the department of motor vehicles or a voter registration agency, so that the voter's name may be changed or transferred, if necessary, to the proper subdivision of the checklist. The voter registration application form may be used to notify the clerk or the board that the voter has changed his or her name or address. (Added 1977, No. 269 (Adj. Sess.), § 1; amended 1981, No. 239 (Adj. Sess.), § 10; 1997, No. 47, § 4; 2001, No. 7, § 1, eff. Jan. 1, 2002; 2003, No. 59, § 4.)


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State Codes and Statutes

Statutes > Vermont > Title-17 > Chapter-43 > 2145

§ 2145. Application forms

(a) The voter registration application shall be in the form approved by the federal election commission or by the secretary of state. The application form approved by the secretary shall include:

(1) A place for the applicant to swear or affirm, by checking the appropriate box, that he or she meets all voter eligibility requirements set forth in section 2121 of this title and a place for the signature of the applicant affirming, under penalty of perjury, that all information submitted by the applicant is accurate and truthful. The affirmation shall include the following information:

(A) The applicant's place and date of birth.

(B) The applicant's town of legal residence.

(C) The applicant's street address or a description of the physical location of the applicant's residence. The description must contain sufficient information so that the town clerk can determine whether the applicant is a resident of the town.

(D)(i) if the applicant has been issued a current and valid driver's license or nondriver's identification, the applicant's driver's license number or nondriver's identification number; or

(ii) if the applicant does not possess a driver's license number, the last four digits of the applicant's Social Security number; or

(iii) if the applicant does not possess a Social Security number, the town clerk shall contact the secretary of state and the secretary shall assign a unique identifier for the applicant.

(2) The voter's oath and a space for a person administering the voter's oath to another to execute the written notification required by section 2124 of this title.

(3) Space for the town clerk to document action on the application.

(4) The following statements:

"If you were provided with this form when you applied for, or renewed, a motor vehicle driver's license or were provided with this application form by a voter registration agency, you may decline to register. If you decline to register, your failure to register will remain confidential and will be used only for voter registration purposes."

"If you are submitting this application in connection with a motor vehicle driver's license application, or renewal, or through a voter registration agency, the office through which you submitted this application will remain confidential and will be used only for voter registration purposes."

(5) The following statement on applications provided by the department of motor vehicles: "Keep this receipt and take it to the polls when you go to vote. This is proof you submitted an application before the deadline for registration."

(b) [Deleted.]

(c) A board of civil authority or town clerk may not require a person to complete any form other than that approved under subsection (a) of this section or section 2145a of this title; nor may the board of civil authority require all applicants or any particular class or group of applicants to appear personally before a meeting of the board or routinely or as a matter of policy require applicants to submit additional information to verify or otherwise support the information contained in the application form.

(d) When the board of civil authority acts on an application to add a name to the checklist, it shall notify the applicant by returning one copy of the completed application to the applicant and shall send one copy of the completed application to the town in which the applicant was last registered to vote, whether within or without the state of Vermont, before adding the applicant's name and mailing address to the checklist. The original application shall be filed in the office of the town clerk.

(e) The secretary of state shall provide each town clerk and voter registration agency with a sufficient number of forms at state expense.

(f) A person who makes a false statement in completing a voter registration application form or the voter registration portion of an application for a motor vehicle driver's license knowing the statement to be false shall be subject to the penalties of perjury as provided in 13 V.S.A. § 2901.

(g) A voter who moves from one address in a town in which that voter is registered to another address in the same town, or whose name has been changed, shall not be required to reapply as provided in this section, but shall notify the town clerk of his or her new name or address, unless such information has been provided to the department of motor vehicles or a voter registration agency, so that the voter's name may be changed or transferred, if necessary, to the proper subdivision of the checklist. The voter registration application form may be used to notify the clerk or the board that the voter has changed his or her name or address. (Added 1977, No. 269 (Adj. Sess.), § 1; amended 1981, No. 239 (Adj. Sess.), § 10; 1997, No. 47, § 4; 2001, No. 7, § 1, eff. Jan. 1, 2002; 2003, No. 59, § 4.)


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