San Luis Obispo County

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You need to print the PDF form, sign it and mail it to:    County Clerk-Election Division
                                                                                           PO Box 8102
                                                                                           San Luis Obispo, CA 93403-9906

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Are you a U.S. citizen?
Yes		No (If no, don't fill out this form.)

Will you be at least 18 years of age on or before election day?
Yes		No (If no, don't fill out this form.)

Indicate your preferred title:
Mr.	Mrs.	Miss	Ms.

Last Name:

First Name:

Middle Name:

Address where you live:(Number, Street, Ave., Road,
Including N, S, E, W,NO PO BOX/BUSINESS ADDRESS):

Apt. #:

City:

State:
CA

Zip Code:

County
San Luis Obispo

If no street address,describe where you live:(Cross Streets, Route, Section, Range, N, S, E, W):

Mailing Address(if different from the address where you live, orPO BOX):

City (or APO/FPO):

State:

Zip Code:

Foreign Country:

Date of Birth
(Month/Day/Year) ,

Place of Birth: - (State or Country Only)

CA driver's license or CA ID card #

SSN (last 4 digits)

Telephone:
() -

E-mail:

Political Party-Select One

American Independent Party

Democratic Party

Green Party

Libertarian Party

Peace & Freedom Party

Republican Party

I Decline to State A Political Party

Other (Specify)

Have you ever been registered to vote? No Yes If Yes, give information from last voter registration form, including political party.
Last Name:	First Name:	MI:
Street Address:	City:	State:	Zip Code:	County:

Prior Political Party:

Permanent Vote-by-Mail Voter	Yes	No
Any voter may apply to become a Permanent Vote-by-Mail Voter. If you check this box you will automatically receive an absentee ballot for each election. For more information please read the instruction below.

Please Check Your Ethnic Background (Optional)

American Indian
or Alaskan Native

Asian

Black

Filipino

Hispanic

Pacific Islander

White

Other (specify)

Can you help in the following areas? (Optional)

Provide a Polling Place Site

Polling Place Worker

Bilingual Polling Place Worker

Instructions:

Mr., Mrs., Miss, Ms.:Prefix to name is optional.

ADDRESS WHERE YOU LIVE:this must be your California residence and domicile. You may not use your business, mailing or secondary address. No PO BOX

CA DRIVER'S LICENSE OR CA ID CARD NUMBER:When you register to vote you must provide your California driver's license or California identification number, if you have one. If you do not have a driver's license or ID card, you must provide the last four digits of your Social Security Number (SSN). If you do not include this information you will be required to provide identification when you vote.

TELEPHONE:Please include area code. This will help elections officials contact you and is posted in precincts on election day. (Optional)

E-MAIL ADDRESS:No person shall be denied the right to register to vote for failure to furnish an e-mail address. The Secretary of State's Office will not use your e-mail address for any other purpose than confirming this request for a voter registration form. However, please be advised that local county elections officials are required to provide voter registration information, which can include an e-mail address, to entities, individuals or organizations for governmental, political and scholastic purposes. (Optional)

POLITICAL PARTY:Ensure you have selected a qualified political party, or "I Decline to State a Political Party" or "Other". If you mark "Other," you may print the name of an unqualified political party. No person shall be entitled to vote the ballot of any political party unless he or she has registered with that party. However, if a voter has declined to state a political party affiliation, and the political party permits it, the unaffiliated voter may vote in the party's primary election.

IF YOU HAVE BEEN REGISTERED TO VOTE:Please complete all information in this section, including political party. If you do not complete all the information it may delay your registration.

PERMANENT VOTE-BY-MAIL VOTER:State law now allows any voter, who so requests, to be a Permanent Vote-by-Mail Voter. Once enrolled you will automatically receive an absentee ballot for every election in which you are entitled to vote. Failure to vote in a statewide election, however, will cancel your Permanent absentee status (not your voter registration) and you will need to reapply for permanent status.

The seven qualified political parties in California are American Independent, Democratic, Green, Libertarian, Natural Law, Peace & Freedom, and Republican.

WARNING: It is illegal to register to vote if you are not eligible or to fraudulently register other persons. Punishable by up to three years in prison.