Please Confirm

I hereby certify that I am a citizen of the United States and a resident of the state of Missouri. I am at least seventeen and one half years of age. I have not been adjudged incapacitated by any court of law. If I have been convicted of a felony or a misdemeanor connected with the right of suffrage, I have had the voting disabilities resulting from such conviction removed pursuant to law. I swear under penalties of perjury that all statements made on this form are true to the best of my knowledge and belief. I understand that if I register to vote knowing that I am not legally entitled to register, I am committing a class one election offense and may be punished by imprisonment of not more than five years or by a fine of between two thousand five hundred dollars and ten thousand dollars or by both such imprisonment and fine.

Warning: Conviction for making a false statement on a voter registration application may result in imprisonment for up to five years and/or a fine up to $10,000.

If you need to make changes, please click the change button at the bottom of this page.

Please sign in the box below. If you are filling out this form on a mobile device, use your finger or stylus.

Please verify your signature. It will be compared to the signature on file.

When submitting your application please assure that the signature you submit is clear and accurate, as it could be used to prove your identity as a registered voter in the future. If you wish to re-sign this form or change any other information, click the change button below.