HomeMy WebLinkAboutDL - Change of Address v6 04-18-23 (fillable) - HawaiiRev. 0/1/202
NOTICE OF CHANGE OF ADDRESS
Street and Apt. or House No., or P.O. Box
City
State
Zip Code
Residence Address
City
State
Zip Code
Mailing Address (Indicate SAME if address is same as your residence address)
City State Zip Code
I DECLINE the opportunity to register to vote or make changes to my voter registration record.
Yes
Are you registered to vote in another state? Provide your last registered address, county, state, and zip code.
Yes. I hereby authorize cancellation of my previous registration.
Yes
Yes
No
No
No
I hereby swear (or affirm) that all information furnished on this application is true and correct.
Warning: Any person who knowingly furnishes false information may be guilty of a Class C felony.
Are you a registered voter?
If you are currently registered to vote in the State of Hawaii, the information provided will be used to update your name and/or address in your voter registration
record. If you are not registered to vote, you may complete and sign the application below to become a registered voter.
YES NO
Phone
Email Yes, I am disabled and unable to read standard print and would like to request an electronic ballot
to be sent to my email address indicated on this application. Applicant must provide email address to receive an electronic ballot.
If you are disabled and unable to read standard print, would you like to receive an electronic ballot?
Date
Notice: The identity of the voter registration agency through which any particular voter was registered shall not be publicly disclosed. A person’s declination to register to vote is also confidential and is used for voter registration purposes only (National Voter Registration Act of 1993).
Date of Birth
SIGNATURE:
Office Use Only
ID Number
DLCOA99
Location Code
98
Document Number
Voter Registration
In order to record this with our office, you must include two proofs of principal residence. Principal residence is defined as the location where a person currently
resides even if the residence location is temporary. Please refer to acceptable proof of principal residence document checklist. File within 30 days of change via in
person, mail or by fax.
Full Legal Name (Last, First, Middle, Suffix)
Qualifications If you answer “No” to any of the questions below STOP.
Are you a citizen of the United States of America?
Are you at least 16 years of age? (Must be 18 to vote)
Are you a resident of the State of Hawaii?
Email:
Phone: (808)
Fax: (808)
Personal Information
Mailing Address
Currently
on Record
New
Address