Full Service Public Agencies (i.e., WIC, FSSA, DFR)
BMV (PLEASE REQUEST TO BECOME REGISTERED AT THE TIME YOU ARE CONDUCTING BUSINESS RELATED TO THE BMV. THIS IS NOT AUTOMATIC) FORMS ARE AVAILABLE FOR YOUR USE. HOWEVER, IF YOU ARE ONLY PICKING UP A FORM IT IS YOUR SOLE RESPONSIBILITY TO SUBMIT THE FORM TO THE VOTER REGISTRATION OFFICE.
To Complete a Voter Registration Application Provide the Following:
- Name
- Residential Address (and mailing address IF different than residential address)
- Voter Identification Number **
- **Voter Identification may be: INDIANA ISSUED DRIVERS LICENSE NUMBER
INDIANA STATE ISSUED I.D. CARD NUMBER
LAST FOUR ONLY OF SOCIAL SECURITY NUMBER
(IF NONE OF THE ABOVE ARE SUPPLIED THE STATE SYSTEM WILL GENERATE A VOTER IDENTIFICATION NUMBER UTILIZING YOUR 2 DIGIT BIRTH MONTH 2 DIGIT BIRTH DATE 2 DIGIT BIRTH YEAR, AND RANDOMLY ASSIGNED 4 DIGIT NUMBERS)
- **Voter Identification may be: INDIANA ISSUED DRIVERS LICENSE NUMBER
- Birth Date (MM/DD/YEAR)
- Signature
PLEASE ENSURE THAT BOXES 11 & 12 ARE MARKED, ALONG WITH YOUR SIGNATURE. REGISTRATION FORMS CANNOT BE PROCESSED IF THESE ITEMS ARE MISSING.
ACKNOWLEDGMENT NOTICE of receipt of your Application:
This notice informs you of your precinct name, poll location and voting districts that apply to you.
If your application is incomplete you will be asked to provide missing information.
IF you DO NOT receive an Acknowledgment Notice within 30 days of filing your application, contact your county Voter Registration Office.
