HomeMy WebLinkAboutCertificate of Voter Registration Request Form JON HENRICKS · County Clerk
AARON BROWN Deputy County Clerk
OFFICE OF THE COUNTY CLERK Elections Division County of Hawaii
Hawaii County Building 25 Aupuni Street Hilo, Hawaii 96720
Request for Certificate of Voter Registration
I, , would like to request a certificate of voter registration. -------------
Full Name: _____________________ _
Residence Address: --------------------
Mailing Address: ___________________ _
Last 4 Digits of SSN: _________________ _
Birthdate: ------------------------
Mail my certificate of voter registration to:
If you are registering to vote for the first time or updating your information, complete and include the voter registration application.
Please enclose a payment of $2.00 by check or money order made payable to: County Director of
Finance. If you have any questions, contact our office at 961-8277.
I authorize _____________ to pick up my certificate of registration.
(Signature)
Mail request and payment to: County of Hawaii
Elections Division
25 Aupuni St, #1502
Hilo, HI 96720
(Date)
Hawai 'i County is an equal opportunity provider and employer.