Register to Vote OR Update Your Voter Registration / /

Eligibility

WARNING: If you checked

'no' in response to either of

these questions, do not

complete this application.

Are you a citizen of the United States of America?

Are you at least eighteen years of age or will you be eighteen years of age on or

before the rst Tuesday following the rst Monday of November of this year?

I am using this form for:

Check all that apply.

Nebraska Secretary of State’s Official Voter Registration Application

Print Your Name

Last First

Middle (name or initial) Sux (Jr, III, if any)

Yes No

New Registration Name Change Address Change Party Change

Registration taken by:

(Name of election ocial or Deputy Registrar)

Date application received in election oce:

WARNING: Any registrant who signs this application knowing that any of the information in the application is false shall be guilty of a Class IV

felony under section 32-1502 of the statutes of Nebraska. The penalty for a Class IV felony is up to two years imprisonment and twelve months

post-release supervision, a ne of up to $10,000.00, or both.

Applicant’s Oath

To the best of my knowledge and belief, I declare under penalty of election falsication that:

(1) I live in the State of Nebraska at the address provided in this application;

(2) I have not been convicted of a felony or, if convicted, my civil rights have been restored;

(3) I have not been ocially found to be non compos mentis (mentally incompetent); and

(4) I am a citizen of the United States.

If you wish to vote in both partisan and nonpartisan primary elections for state and local oces, you must indicate a political party aliation on

the registration application. If you register without a political party aliation (nonpartisan), you will receive only the nonpartisan ballots for state

and local oces at primary elections. If you register without a political party aliation, you may vote in partisan primary elections for

congressional oces by requesting a nonpartisan/partisan ballot of your choice.

Address Where You Live

Residential Only.

Street Address

Apartment or Lot (if any)

City, State, ZIP

Address Where You

Receive Mail

Same as above OR

Optional

Contact Information

Check box(es) if private.

Phone Number(s)

Email Address

Previous Registration

Information

Previous Name

Previous Address

Political Party

Must choose one.

Date

Assistance

Fill in if someone helped you with this form or

witnessed you make a mark for your signature.

Name Address

Phone Signature of Assistant x

Application Code: O0724

Legal Marijuana NOW

Libertarian Republican Democratic

Nonpartisan (No Party)

(Print party name. Must be a party currently recognized in Nebraska.)

Other

Identication

If you do not have a Nebraska

Driver’s License or State ID,

please provide the last 4

digits of your Social Security

Number.

Mailing Address

Apartment or Lot (if any)

City, State, ZIP

Your Signature or Mark

Date of Birth (mm/dd/yyyy)

Nebraska Driver’s License/State ID Number

Last 4 digits of Social Security Number (SSN)

Place of Birth (City and State or Country)

Maiden Name (if applicable)

/ /

No Labels Nebraska

Find your county election oce listed in red below.

Adams / 500 W 4th Ste 109

Hastings / 68902-2067

Cheyenne / PO BOX 217

Sidney / 69162

Furnas / PO BOX 387

Beaver City / 68926

Johnson / PO BOX 416

Tecumseh / 68450

Nuckolls / PO BOX 366

Nelson / 68961

Sheridan / PO BOX 39

Rushville / 69360

Antelope / PO BOX 26

Neligh / 68756-0026

Clay / 111 W Faireld St

Clay Center / 68933

Gage / PO BOX 429

Beatrice / 68310

Kearney / PO BOX 339

Minden / 68959

Otoe / 1021 Central Ave, Rm 103

Nebraska City / 68410

Sherman / PO BOX 456

Loup City / 68853

Arthur / PO BOX 126

Arthur / 69121

Colfax / 411 E 11th St

Schuyler / 68661

Garden / PO BOX 350

Oshkosh / 69154

Keith / 511 N Spruce Ste 102

Ogallala / 69153

Pawnee / PO BOX 431

Pawnee City / 68420

Sioux / PO BOX 158

Harrison / 69346

Banner / PO BOX 67

Harrisburg / 69345

Cuming / 200 S Lincoln St.

Rm 100 / West Point / 68788

Gareld / PO BOX 218

Burwell / 68823-0218

Keya Paha / PO BOX 349

Springview / 68778

Perkins / PO BOX 156

Grant / 69140

Stanton / PO BOX 347

Stanton / 68779

Blaine / 145 Lincoln Ave

Brewster / 68821

Custer / 431 S 10th St

Broken Bow / 68822

Gosper / PO BOX 136

Elwood / 68937

Kimball / 114 E 3rd St Ste 6

Kimball / 69145

Phelps / PO BOX 404

Holdrege / 68949

Thayer / 225 N 4th Rm 201

Hebron / 68370

Boone / 222 S 4th St

Albion / 68620-1247

Dakota / PO BOX 39

Dakota City / 68731

Grant / PO Box 139

Hyannis / 69350

Knox / PO BOX 166

Center / 68724

Pierce / 111 W Court Rm 1

Pierce / 68767

Thomas / PO BOX 226

Thedford / 69166

Box Butte / PO BOX 678

Alliance / 69301

Dawes / 451 Main St

Chadron / 69337

Greeley / PO Box 287

Greeley / 68842

Lancaster / 601 N 46th St

Lincoln / 68503

Platte / 1464-26th Ave Ste 300

Columbus / 68601

Thurston / PO BOX 159

Pender / 68047

Boyd / PO BOX 26

Butte / 68722

Dawson / 700 N Washington

Rm A / Lexington / 68850

Hall / 121 S Pine St, Ste. 8

Grand Island / 68801

Lincoln / 301 N Jeers Rm 101

North Platte / 69101

Polk / PO BOX 276

Osceola / 68651

Valley / 125 S 15th St

Ste 202 / Ord / 68862

Brown / PO BOX 25

Ainsworth / 69210

Deuel / PO BOX 327

Chappell / 69129

Hamilton / 1111-13th St Ste 1

Aurora / 68818-2017

Logan / PO BOX 8

Stapleton / 69163

Red Willow / 502 Norris Ave

McCook / 69001

Washington / PO BOX 466

Blair / 68008

Bualo / PO BOX 1270

Kearney / 68848

Dixon / PO BOX 546

Ponca / 68770

Harlan / PO BOX 698

Alma / 68920-0698

Loup / PO BOX 187

Taylor / 68879

Richardson / 1700 Stone St

Rm 203 / Falls City / 68355

Wayne / 510 N Pearl St

Ste 5 / Wayne / 68787

Burt / PO BOX 87

Tekamah / 68061

Dodge / 435 N Park Ave

Rm 102 / Fremont / 68025

Hayes / PO BOX 370

Hayes Center / 69032

Madison / PO BOX 290

Madison / 68748

Rock / PO BOX 367

Bassett / 68714

Webster / PO BOX 250

Red Cloud / 68970

Butler / 451 N 5th St

David City / 68632

Douglas / 12220 W Center Rd

Omaha / 68144

Hitchcock / PO BOX 248

Trenton / 69044

McPherson / PO BOX 122

Tryon / 69167

Saline / PO BOX 865

Wilber / 68465

Wheeler / PO BOX 127

Bartlett / 68622

Cass / 145 N 4th St Rm 201

Plattsmouth / 68048

Dundy / PO BOX 506

Benkelman / 69021-0506

Holt / PO BOX 329

O’Neill / 68763

Merrick / PO BOX 27

Central City / 68826

Sarpy / 1102 E 1st St., Ste. 1

Papillion / 68046

York / 510 Lincoln Ave Rm 103

York / 68467

Cedar / PO BOX 47

Hartington / 68739

Fillmore / PO BOX 307

Geneva / 68361

Hooker / PO BOX 184

Mullen / 69152

Morrill / PO BOX 610

Bridgeport / 69336

Saunders / PO BOX 61

Wahoo / 68066

Chase / PO BOX 1299

Imperial / 69033

Franklin / PO BOX 146

Franklin / 68939

Howard / PO BOX 25

St Paul / 68873

Nance / PO BOX 338

Fullerton / 68638

Scotts Blu / 1825 10th St

Gering / 69341

Cherry / PO BOX 120

Valentine / 69201

Frontier / PO BOX 40

Stockville / 69042

Jeerson / 411-4th St

Fairbury / 68352

Nemaha / 1824 N St Ste 201

Auburn / 68305

Seward / PO BOX 190

Seward / 68434

Nebraska Secretary of State’s Ocial

Voter Registration Frequently Asked Questions

How can I check to see if I am already registered to vote? Check your

voter registration at ne.gov/go/votercheck.

How do I know I completed this form correctly? Within 10-14 days,

your county election oce will send either:

• An acknowledgement to you verifying the information on your

application and advising you of your polling location, or

• An incomplete notice to you requesting additional information to

ensure your voter registration record is accurate, or

• A request for valid photo ID, or other documentation if you are a

rst time registrant in Nebraska, registering by mail.

What can I use the form for? You can use this form to register to vote in

Nebraska or update any information on your voter registration including

signature. You must re-register to vote whenever you change your:

• Name

• Residential or Mailing Address

• Political Party Aliation

• Signature

Failure to vote in a previous election does not require re-registration.

Where do I send this form? Return the completed form to your county

election oce at the address listed below.

By mail

Must be postmarked by the 3rd Friday prior to any election. If you are

mailing this application and are a rst time registrant in Nebraska, law

requires a copy of a photo identication which is current and valid or a

copy of a utility bill, bank statement, government check, paycheck, or

other government document that is dated within 60 days before the date

you register and shows your name and residence address.

By personal messenger or agent

Must be delivered to your county election oce by the 3rd Friday prior to

any election.

In person

Must appear at your county election oce by 6 p.m. on the 2nd Friday

prior to any election.

Questions? Contact your local election oce, or the Nebraska Secretary

of State by phone at 402-471-2555 or toll free at 888-727-0007; via our

website: sos.nebraska.gov; or email SOS.ELECT@nebraska.gov.

What if I am unable to sign this form? If you are unable to sign this

form, any person may print your name in the signature section of the

form and you may make a mark next to your printed name. This qualies

as a valid signature. The person providing assistance should ll out the

assistance section located underneath the signature section.

What determines residence? By law, (Neb. Rev. Stat. §32-116), your

residence is that place at which you have established a home, where you

are habitually present, and to which, when you depart, you intend to

return. You do not need to change your residence for voting purposes if

you leave for temporary purposes, such as military service, school

attendance, hospital stays, or missions work. However, any permanent

change in your residence or address will require you to re-register to

vote. You may only register and vote in one place.

Can I register or update my voter registration online? Yes, if you have

a valid Nebraska driver’s license or state-issued identication card, you

can register online at ne.gov/go/NEReg2Vote.

Which information is condential? By law, (Neb. Rev. Stat. §32-330), all

information becomes part of a public record and may be included in

public service requests related to elections, political activities, voter

registration, law enforcement or jury selection. Exceptions include:

• Driver’s License or State ID number

• Last 4 digits of your SSN

• Signature

• Phone numbers and email

addresses you marked private

If you are a program participant under the Address Condentiality Act or

you have a court order showing good cause that a life-threatening

circumstance exists in relation to you or a member of your household,

your voter registration will remain condential. You must submit a voter

condentiality adavit at the time of registering to be designated as a

condential voter. For more information, contact your local election

oce.

• Place of birth

• Maiden name

• Source of registration

• Previous registration

information