
DL-64 10/2021
No Waiting in Line! – Change your address online at
https://www.texas.gov/txt
I understand that giving false information to procure a voter registration is perjury, and a crime under state and federal law. Conviction
of this crime may result in imprisonment up to 180 days, a ne up to $2,000, or both. PLEASE READ ALL THREE STATEMENTS TO
AFFIRM BEFORE SIGNING.
I am a resident of the county provided above, and a U.S. citizen; I have not been nally convicted of a felony, or if a felon, I have completed all
of my punishment including any term of incarceration, parole, supervision, period of probation, or I have been pardoned; And I have not been
determined by a nal judgment of a court exercising probate jurisdiction to be totally mentally incapacitated or partially mentally incapacitated
without the right to vote.
By providing my electronic signature, I understand the personal information on my application form and my electronic signature will be used for
submitting my voter’s registration application to the Texas Secretary of State’s ofce. Wanting to register to vote, I authorize the Department of
Public Safety to transfer this information to the Texas Secretary of State.
In the event of injury or death would you like to provide two (2) emergency contacts? If yes, please print clearly:
If you are a U.S. citizen, would you like to register to vote? If registered, would you like to update your voter information?
Yes No
Would you like to be an Election Judge?
Yes No
CERTIFICATION
I do solemnly swear, affirm, or certify that I am the person named herein and that the statements on this application are true and
correct. I further certify my residence address is a (select one): single family dwelling, apartment, motel, temporary shelter.
I agree to immediately report to the Texas Department of Public Safety any changes in my medical condition which may affect my ability to
safely operate a motor vehicle. I further understand that I am required by law to report any change of name or address to the Department
of Public Safety within thirty days.
Signature of Applicant _________________________________________________ Date _________________________
If you currently hold a valid Texas non-commercial driver license or identication card and have not reported your change of address as required
by TRC 521.054 and Administrative Code 15.25, you may do so by mail or on the Internet. To report a change of address by mail, complete
this form and mail along with the required fee(s) to the Texas Department of Public Safety. To report a change of address online, go to
https://www.texas.gov/txt. A driver license or identication card validating your reported address change will be mailed to you.
This form may ONLY be used to change your address or obtain a replacement DL or ID card. If you need to change information other than your
address or desire a new photo, you must make an appointment at the local driver license ofce.
United States Selective Service
Any male at least 18 but younger than 26 years of age submitting this application consents to registration with the United States Selective Service
System. Alternative options for those who object to conventional military service for religious or other conscientious reasons may be found at:
https://www.sss.gov/About/Alternative-Service. By submitting this application, I am consenting to registration with the United States Selective
Service System if my registration is required by federal law.
First Name Last Name
First Name Last Name
Street Address Phone Number
Street Address Phone Number
City State Zip Code
City State Zip Code
*2641021*