Application to register

1. REGISTRATION
Wikiwiki form and a postage stamp.
Officers of Hawaii are pleased to
i n t ro d u c e y o u t o W i k i w i k i Vo t e r
Registration, Hawaii’s registration-by-
Follow the instructions and complete
registered to vote, please remember
The Office of Elections and the
Association of Clerks and Election
To register to vote, all you need is a
the form correctly. Once you have
to take the next step and VOTE in the
upcoming elections. See you there!
VOTER
INSTRUCTIONS FOR COMPLETING THE WIKIWIKI VOTER REGISTRATION FORM
STEP 1 Complete the Affidavit on Application for Voter Registration
1. Print your Social Security Number.
2. Print your Date of Birth.
mail procedure.
3. Print your “Home” and “Business” telephone numbers.
Aloha
4. Print your Name - Last, First and Middle Initial(s).
5. Print your Residence Address in Hawaii (house number and street name). You must be registered to
vote in the county and precinct where you live.
Note: A Post Office Box, Star Route, Rural Route, General Delivery, Business Address or
Mailing Service Address is not an acceptable residence address.
6. Print your Mailing Address in Hawaii.
7. If your residence does not have a street address, describe the location of your residence. Include
details such as subdivision, village, tax map key no. and zip code.
8. Check the appropriate “Female” or “Male” box.
9. If you are registered to vote in another state but now wish to register to vote in Hawaii, complete box #9.
Your registration in that state will be canceled.
Note: You may register to vote in only one state.
10. Read carefully, mark the appropriate “Yes” or “No” box and sign on the line provided. Your application
will not be accepted if you fail to mark the appropriate boxes or withhold your signature.
11. If your signature is a mark, a witness signature is required.
Notice to First Time Voters Who Register to Vote by Mail:
If you are (1) registering to vote for the first time in the State of Hawaii; and (2) are mailing in this Affidavit on Application
for Voter Registration, federal law (42 U.S.C. § 15483) requires you to provide proof of identification. Proof of identification
includes a copy of:
• A current and valid photo identification, or
• A current utility bill, bank statement, government check, paycheck or government document that shows your name and
address.
If you do not provide the required proof of identification with this Affidavit on Application for Voter Registration, you will be
required to do so at your polling place, or with your voted absentee mail-in ballot.
STEP 2 Mail the Affidavit on Application for Voter Registration no later than 30 days prior to the
election to the appropriate City/County Clerk:
County of Hawaii City and County of Honolulu
25 Aupuni St., Rm. 105 530 S. King St., Rm. 100
Hilo, HI 96720-4245 Honolulu, HI 96813-3077
Tulong para iti Lengguahe – Filipino (Ilocano)
Opisina ti Eskribiente iti Siudad/Ili. Pangaasim
ta awaganyo ti maitutop a numero iti telepono a
introduce you to Wikiwiki Voter Registration, Hawaii’s
available at the Office of the City/County Clerk. Please
Ti Opisina ti Panagpipili ken ti Timpuyog dagiti
Eskribiente ken Eleksion Opiser ti Hawaii
maragsakanda a mangiyammo kenka ti Wikiwiki a
Panagrehistro ti Botante, ti Panagrehistro iti Hawaii
babaen ti koreo a wagas. Dagiti naipatarus a
kasapulan iti panagbutos a mangtulong kenka
iti panangileppas iti daytoy a porma maalada iti
The Office of Elections and the Association of Clerks
and Election Officers of Hawaii are pleased to
registration-by-mail procedure. Translated voting
materials to assist you in completing this form are
Clerks and Election Officers of Hawaii) 発行の ィ
これは選挙管理委員会(The Office of Elections)
ご入り用の際は下記
選挙管理員協会 (The Association of
紙記入の際に必要な手引き書の日本語訳は最寄りの
市または郡の書記官事務所 (The Office of the City/
うになりま
「ウ
この申請用
Ph. (808) 961-8277 Ph. (808) 768-3800
Filipino, Chinese, and Japanese translations are required
For more information, please call the Office of
pursuant to the Voting Rights Act of 1965 as amended.
LANGUAGE ASSISTANCE
call the appropriate phone number listed below.
County of Maui County of Kauai
選挙人名簿登録が郵便で行えるよ
200 S. High St., Rm. 708 4386 Rice St.
です。
Wailuku, HI 96793-2155 Lihue, HI 96766-1371
キウ キ選挙人名簿登録申請用紙」
Ph. (808) 270-7749 Ph. (808) 241-4800
(808) 768-3800
(808) 270-7749
(808) 241-4800
(808) 961-8277
り入手できます。
ださい。
言語サービス – Japanese
the City/County Clerk:
の番号にお問い合わせく
English (Translation)
– Chinese
nailanad ditoy baba.
County Clerk) よ
並びに書記官、
Honolulu:
Hawaii:
Kauai:
Maui:
この度、
した。
ィ

2. VOTING IN HAWAII AFFIDAVIT ON APPLICATION FOR VOTER REGISTRATION
Voting is an essential part of our democratic process. By voting, you choose the representatives who will make STATE OF HAWAII IMPORTANT: PRINT CLEARLY
AFFIDAVIT NO.
decisions affecting you, your family and your community. If you care about the future of Hawaii. . . . IN BLACK INK. FAILURE TO
}ss.
register and VOTE!! County of Hawaii
COMPLETE ALL ITEMS WILL
County of Kauai
PREVENT ACCEPTANCE OF
What Types of Elections Does Hawaii Hold? Will I Be Notified of My Polling Place? County of Maui THIS APPLICATION. (FOR OFFICE USE ONLY)
City and County of Honolulu
In every even numbered year, Hawaii holds a Primary Election Yes. Your City/County Clerk will send you a Notice of Voter
in September and a General Election in November. Registration and Address Confirmation (NVRAC) card
with your polling place listed on it. I HEREBY SWEAR (OR AFFIRM) THAT THE FOLLOWING INFORMATION IS TRUE AND CORRECT:
Who May Register to Vote?
SOCIAL SECURITY NUMBER* DATE OF BIRTH TELEPHONE
You are not properly registered if:
You may register to vote if you are: you do not receive the NVRAC card; 1 ___ ___ ___ - ___ ___ - ___ ___ ___ ___ 2 ___ ___ / ___ ___ / ___ ___ 3
Month Day Year Home: Business:
a citizen of the United States of America; you no longer live at the address listed on the
a legal resident of Hawaii; and LAST NAME FIRST NAME MIDDLE INITIAL(S)
NVRAC card; or 4
at least 16 years of age (Pre-registration is allowed at your residence address on the NVRAC is the address of a
age 16. You must be 18 years old by election day to vote). mailing service or a business. RESIDENCE ADDRESS IN HAWAII (Must be completed. P.O. Box, R.R., S.R. are not acceptable) CITY/TOWN ZIP CODE
5
You are not eligible to register or to vote if you are a Do I Need an I.D. to Vote on Election Day? MAILING ADDRESS IN HAWAII (Street address or P.O. Box) CITY/TOWN ZIP CODE
convicted and confined felon or you are declared mentally 6
incompetent. Yes. Be sure to have an I.D. with a picture and signature If no street/residence address, describe location of residence (leave blank if box #5 is completed) CITY/TOWN ZIP CODE
(such as a Hawaii driver’s license or state I.D. card) when 7
Should I Re-register to Vote? you go to vote. The NVRAC card is not an acceptable form
GENDER ARE YOU A REGISTERED VOTER IN ANOTHER STATE?
of identification. If “yes”, please complete the following: I was last registered to vote at:
You should re-register if you changed your name, residence Female
8 9 in the county of
address or mailing address. Do I Have to Take Time Off from Work to Vote? Male (Last Registered Address) (County) (State) (Zip Code)
and hereby authorize cancellation of my previous voter registration.
How Long are the Polls Open? You may be entitled to not more than two consecutive hours READ CAREFULLY, MARK APPROPRIATE “YES” OR “NO” BOX, AND SIGN BELOW.
off from work on election day in order to vote. Ask your
Polling places are open from 7:00 A.M. to 6:00 P.M. If you are employer first and keep your ballot stub as proof of voting I hereby swear (or affirm) that:
not sure of your polling place, call your City or County Clerk. (ref. HRS §11-95).
FOR FEDERAL, STATE, and COUNTY ELECTIONS:
a. I am a citizen of the United States of America (Non-U.S. citizens including U.S. nationals do not qualify). Yes No
b. I am at least 16 years of age. I understand that I must be 18 years old by election day to vote. Yes No
10
SPECIAL VOTING SERVICES For additional information, call the Voter Hotline at:
c. I am a resident of the State of Hawaii.
The residence stated in this affidavit is not simply because of my presence in the State, but that the residence was acquired
with the intent to make Hawaii my legal residence with all the accompanying obligations therein……… Yes No
Any voter who requires assistance to vote by reason (808) 453-VOTE (8683)
of physical, visual, or hearing disability, or an inability
to read or write may be given assistance by a person Neighbor Islands call toll-free: SIGNATURE
of the voter’s choice -- other than the voter’s employer, DATE
agent of the employer, or agent of the voter’s union 1-800-442-VOTE (8683) WITNESS SIGNATURE (required only if applicant makes a mark) DATE
(42 U.S.C. 1973aa-6).
Website address: www.hawaii.gov/elections 11 ADDRESS OF WITNESS PHONE NO. OF WITNESS
Every polling place has a Voter Assistance Official
who can provide the following: Persons with hearing or speech disabilities should
language assistance materials to voters who have call the Office of Elections’ TTY phone at: ANY PERSON WHO KNOWINGLY FURNISHES FALSE INFORMATION MAY BE GUILTY OF A CLASS C
difficulty with the English language; (808) 453-6150 WARNING
FELONY, PUNISHABLE BY UP TO 5 YEARS OF IMPRISONMENT AND/OR $10,000 FINE.
assistance to voters with physical disabilities; and
curbside voting services to voters who are unable Neighbor Islands call TTY toll-free: * Notice: Section 11-15 of the Hawaii Revised Statutes requires that a person registering to vote provide, under oath, his or her social security number, if any.
to leave their vehicles to vote. 1-800-345-5915 An application lacking this information will, therefore, be denied. Pursuant to Section 7 of the Federal Privacy Act (P.L. 93-579), be advised that this
information may be released to government agencies for government purposes.
or the Sprint Relay Hawaii TRS at:
711 (V/TTY); 847-9508 (FAX) For Office Use Only
Voice Carry Over (VCO): 1 (877) 447-5992 I.D. No. LOCATION CODE REPRESENTATIVE DISTRICT/PRECINCT
Speech to Speech (STS): 1 (877) 447-8711 12 13 14
_____ _____ _____ _____ _____ _____ _____ _____ _____ _____
The office at which a person registers to vote is confidential. 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). 05/08
Prepared by the Office of Elections and the Association of Clerks and Election Officers of Hawaii (05/08).

3. VOTING IN HAWAII AFFIDAVIT ON APPLICATION FOR VOTER REGISTRATION
Voting is an essential part of our democratic process. By voting, you choose the representatives who will make STATE OF HAWAII IMPORTANT: PRINT CLEARLY
AFFIDAVIT NO.
decisions affecting you, your family and your community. If you care about the future of Hawaii. . . . IN BLACK INK. FAILURE TO
}ss.
register and VOTE!! County of Hawaii
COMPLETE ALL ITEMS WILL
County of Kauai
PREVENT ACCEPTANCE OF
What Types of Elections Does Hawaii Hold? Will I Be Notified of My Polling Place? County of Maui THIS APPLICATION. (FOR OFFICE USE ONLY)
City and County of Honolulu
In every even numbered year, Hawaii holds a Primary Election Yes. Your City/County Clerk will send you a Notice of Voter
in September and a General Election in November. Registration and Address Confirmation (NVRAC) card
with your polling place listed on it. I HEREBY SWEAR (OR AFFIRM) THAT THE FOLLOWING INFORMATION IS TRUE AND CORRECT:
Who May Register to Vote?
SOCIAL SECURITY NUMBER* DATE OF BIRTH TELEPHONE
You are not properly registered if:
You may register to vote if you are: you do not receive the NVRAC card; 1 ___ ___ ___ - ___ ___ - ___ ___ ___ ___ 2 ___ ___ / ___ ___ / ___ ___ 3
Month Day Year Home: Business:
a citizen of the United States of America; you no longer live at the address listed on the
a legal resident of Hawaii; and LAST NAME FIRST NAME MIDDLE INITIAL(S)
NVRAC card; or 4
at least 16 years of age (Pre-registration is allowed at your residence address on the NVRAC is the address of a
age 16. You must be 18 years old by election day to vote). mailing service or a business. RESIDENCE ADDRESS IN HAWAII (Must be completed. P.O. Box, R.R., S.R. are not acceptable) CITY/TOWN ZIP CODE
5
You are not eligible to register or to vote if you are a Do I Need an I.D. to Vote on Election Day? MAILING ADDRESS IN HAWAII (Street address or P.O. Box) CITY/TOWN ZIP CODE
convicted and confined felon or you are declared mentally 6
incompetent. Yes. Be sure to have an I.D. with a picture and signature If no street/residence address, describe location of residence (leave blank if box #5 is completed) CITY/TOWN ZIP CODE
(such as a Hawaii driver’s license or state I.D. card) when 7
Should I Re-register to Vote? you go to vote. The NVRAC card is not an acceptable form
GENDER ARE YOU A REGISTERED VOTER IN ANOTHER STATE?
of identification. If “yes”, please complete the following: I was last registered to vote at:
You should re-register if you changed your name, residence Female
8 9 in the county of
address or mailing address. Do I Have to Take Time Off from Work to Vote? Male (Last Registered Address) (County) (State) (Zip Code)
and hereby authorize cancellation of my previous voter registration.
How Long are the Polls Open? You may be entitled to not more than two consecutive hours READ CAREFULLY, MARK APPROPRIATE “YES” OR “NO” BOX, AND SIGN BELOW.
off from work on election day in order to vote. Ask your
Polling places are open from 7:00 A.M. to 6:00 P.M. If you are employer first and keep your ballot stub as proof of voting I hereby swear (or affirm) that:
not sure of your polling place, call your City or County Clerk. (ref. HRS §11-95).
FOR FEDERAL, STATE, and COUNTY ELECTIONS:
a. I am a citizen of the United States of America (Non-U.S. citizens including U.S. nationals do not qualify). Yes No
b. I am at least 16 years of age. I understand that I must be 18 years old by election day to vote. Yes No
10
SPECIAL VOTING SERVICES For additional information, call the Voter Hotline at:
c. I am a resident of the State of Hawaii.
The residence stated in this affidavit is not simply because of my presence in the State, but that the residence was acquired
with the intent to make Hawaii my legal residence with all the accompanying obligations therein……… Yes No
Any voter who requires assistance to vote by reason (808) 453-VOTE (8683)
of physical, visual, or hearing disability, or an inability
to read or write may be given assistance by a person Neighbor Islands call toll-free: SIGNATURE
of the voter’s choice -- other than the voter’s employer, DATE
agent of the employer, or agent of the voter’s union 1-800-442-VOTE (8683) WITNESS SIGNATURE (required only if applicant makes a mark) DATE
(42 U.S.C. 1973aa-6).
Website address: www.hawaii.gov/elections 11 ADDRESS OF WITNESS PHONE NO. OF WITNESS
Every polling place has a Voter Assistance Official
who can provide the following: Persons with hearing or speech disabilities should
language assistance materials to voters who have call the Office of Elections’ TTY phone at: ANY PERSON WHO KNOWINGLY FURNISHES FALSE INFORMATION MAY BE GUILTY OF A CLASS C
difficulty with the English language; (808) 453-6150 WARNING
FELONY, PUNISHABLE BY UP TO 5 YEARS OF IMPRISONMENT AND/OR $10,000 FINE.
assistance to voters with physical disabilities; and
curbside voting services to voters who are unable Neighbor Islands call TTY toll-free: * Notice: Section 11-15 of the Hawaii Revised Statutes requires that a person registering to vote provide, under oath, his or her social security number, if any.
to leave their vehicles to vote. 1-800-345-5915 An application lacking this information will, therefore, be denied. Pursuant to Section 7 of the Federal Privacy Act (P.L. 93-579), be advised that this
information may be released to government agencies for government purposes.
or the Sprint Relay Hawaii TRS at:
711 (V/TTY); 847-9508 (FAX) For Office Use Only
Voice Carry Over (VCO): 1 (877) 447-5992 I.D. No. LOCATION CODE REPRESENTATIVE DISTRICT/PRECINCT
Speech to Speech (STS): 1 (877) 447-8711 12 E 1 0 0
_____ _____ _____ _____
13
_____ _____
14 _____ _____ _____ _____
The office at which a person registers to vote is confidential. 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). 05/08
Prepared by the Office of Elections and the Association of Clerks and Election Officers of Hawaii (05/08).

4. REGISTRATION
Wikiwiki form and a postage stamp.
Officers of Hawaii are pleased to
i n t ro d u c e y o u t o W i k i w i k i Vo t e r
Registration, Hawaii’s registration-by-
Follow the instructions and complete
registered to vote, please remember
The Office of Elections and the
Association of Clerks and Election
To register to vote, all you need is a
the form correctly. Once you have
to take the next step and VOTE in the
upcoming elections. See you there!
VOTER
INSTRUCTIONS FOR COMPLETING THE WIKIWIKI VOTER REGISTRATION FORM
STEP 1 Complete the Affidavit on Application for Voter Registration
1. Print your Social Security Number.
2. Print your Date of Birth.
mail procedure.
3. Print your “Home” and “Business” telephone numbers.
Aloha
4. Print your Name - Last, First and Middle Initial(s).
5. Print your Residence Address in Hawaii (house number and street name). You must be registered to
vote in the county and precinct where you live.
Note: A Post Office Box, Star Route, Rural Route, General Delivery, Business Address or
Mailing Service Address is not an acceptable residence address.
6. Print your Mailing Address in Hawaii.
7. If your residence does not have a street address, describe the location of your residence. Include
details such as subdivision, village, tax map key no. and zip code.
8. Check the appropriate “Female” or “Male” box.
9. If you are registered to vote in another state but now wish to register to vote in Hawaii, complete box #9.
Your registration in that state will be canceled.
Note: You may register to vote in only one state.
10. Read carefully, mark the appropriate “Yes” or “No” box and sign on the line provided. Your application
will not be accepted if you fail to mark the appropriate boxes or withhold your signature.
11. If your signature is a mark, a witness signature is required.
Notice to First Time Voters Who Register to Vote by Mail:
If you are (1) registering to vote for the first time in the State of Hawaii; and (2) are mailing in this Affidavit on Application
for Voter Registration, federal law (42 U.S.C. § 15483) requires you to provide proof of identification. Proof of identification
includes a copy of:
• A current and valid photo identification, or
• A current utility bill, bank statement, government check, paycheck or government document that shows your name and
address.
If you do not provide the required proof of identification with this Affidavit on Application for Voter Registration, you will be
required to do so at your polling place, or with your voted absentee mail-in ballot.
STEP 2 Mail the Affidavit on Application for Voter Registration no later than 30 days prior to the
election to the appropriate City/County Clerk:
County of Hawaii City and County of Honolulu
25 Aupuni St., Rm. 105 530 S. King St., Rm. 100
Hilo, HI 96720-4245 Honolulu, HI 96813-3077
Tulong para iti Lengguahe – Filipino (Ilocano)
Opisina ti Eskribiente iti Siudad/Ili. Pangaasim
ta awaganyo ti maitutop a numero iti telepono a
introduce you to Wikiwiki Voter Registration, Hawaii’s
available at the Office of the City/County Clerk. Please
Ti Opisina ti Panagpipili ken ti Timpuyog dagiti
Eskribiente ken Eleksion Opiser ti Hawaii
maragsakanda a mangiyammo kenka ti Wikiwiki a
Panagrehistro ti Botante, ti Panagrehistro iti Hawaii
babaen ti koreo a wagas. Dagiti naipatarus a
kasapulan iti panagbutos a mangtulong kenka
iti panangileppas iti daytoy a porma maalada iti
The Office of Elections and the Association of Clerks
and Election Officers of Hawaii are pleased to
registration-by-mail procedure. Translated voting
materials to assist you in completing this form are
Clerks and Election Officers of Hawaii) 発行の ィ
これは選挙管理委員会(The Office of Elections)
ご入り用の際は下記
選挙管理員協会 (The Association of
紙記入の際に必要な手引き書の日本語訳は最寄りの
市または郡の書記官事務所 (The Office of the City/
うになりま
「ウ
この申請用
Ph. (808) 961-8277 Ph. (808) 768-3800
Filipino, Chinese, and Japanese translations are required
For more information, please call the Office of
pursuant to the Voting Rights Act of 1965 as amended.
LANGUAGE ASSISTANCE
call the appropriate phone number listed below.
County of Maui County of Kauai
選挙人名簿登録が郵便で行えるよ
200 S. High St., Rm. 708 4386 Rice St.
です。
Wailuku, HI 96793-2155 1819
Lihue, HI 96766-1371
キウ キ選挙人名簿登録申請用紙」
Ph. (808) 270-7749 Ph. (808) 241-4800
(808) 768-3800
(808) 270-7749
(808) 241-4800
(808) 961-8277
り入手できます。
ださい。
言語サービス – Japanese
the City/County Clerk:
の番号にお問い合わせく
English (Translation)
– Chinese
nailanad ditoy baba.
County Clerk) よ
並びに書記官、
Honolulu:
Hawaii:
Kauai:
Maui:
この度、
した。
ィ