Utah Code § 20A-2-104 — Utah Code / Title 20A / Chapter 20A-2 / § 20A-2-104
§ 20A-2-104. Voter registration form -- Registered voter lists -- Fees for copies.
Status: in_force

(1) (a) An individual applying for voter registration, or an individual preregistering to vote, shall complete a voter registration form in substantially the following form: (i) the first part of the form shall include the following:"---------------------------------------------------------------------------------------------------------UTAH ELECTION REGISTRATION FORMAre you a citizen of the United States of America?YesNoIf you checked "no" to the above question, do not complete this form.Will you be 18 years old on or before election day?YesNoIf you checked "no" to the above question, are you 16 or 17 years old and preregistering to vote?YesNoIf you checked "no" to both of the prior two questions, do not complete this form.You must be a United States citizen to vote. If you fail to provide proof of United States citizenship, you will only be permitted to vote for federal offices. Information on how to provide proof of citizenship is included on the back of this form.Name of Voter _________________________________________________________________First Middle LastUtah Driver License or Utah Identification Card Number____________________________Date of Birth ______________________________________________________Street Address of Principal Place of Residence____________________________________________________________________________City County State Zip CodeTribal Identification Number or Alien Registration Number (optional) ______________________________Telephone Number (optional) _________________________Email Address (optional) _____________________________________________"; (ii) beginning on January 1, 2027, immediately following the portion of the form described in Subsection (1)(a)(i), the form shall include the following:"Do you consent to the election officer providing the following information to the political party with which you affiliate? (optional): The email address you provided above? Yes No The phone number you provided above? Yes No"; and (iii) following the portions of the form required under Subsections (1)(a)(i) and (ii), the form shall include the following:"Last four digits of Social Security Number ______________________Last former address at which I was registered to vote (if known)______________________________________________________________________________________________________CityCountyState Zip CodePolitical Party(a listing of each registered political party, as defined in Section 20A-8-101 and maintained by the lieutenant governor under Section 67-1a-2, with each party's name preceded by a checkbox)Unaffiliated (no political party preference) Other (Please specify)___________________I do swear (or affirm), subject to penalty of law for false statements, that the information contained in this form is true, and that I am a citizen of the United States and a resident of the state of Utah, residing at the above address. Unless I have indicated above that I am preregistering to vote in a later election, I will be at least 18 years old and will have resided in Utah for 30 calendar days immediately before the next election. I am not a convicted felon currently incarcerated for commission of a felony.Signed and sworn__________________________________________________________Voter's Signature_______________(month/day/year).PRIVACY INFORMATIONVoter registration records contain some information that is available to the public, such as your name, address, and age range. Your date of birth, driver license number, state identification card number, and social security number are available only to an authorized government entity. Your email address and phone number are also only available to an authorized government entity, unless you have consented, above, to disclose them to the political party with which you choose to affiliate.REQUEST FOR ADDITIONAL PRIVACY PROTECTIONIn addition to the protections provided above, you may request that your voter registration record be withheld from public disclosure if you are, or reside with: an individual who is a victim of, or is threatened with, domestic violence or dating violence; a law enforcement officer; a member of the armed forces; a public figure; or an individual who is protected by a court order.To make this request for additional privacy protection, you must prove that you qualify by submitting an at-risk designation request form, and any required proof, to your county clerk. You may obtain the form, and information on the proof required, from your county clerk or at the following website [insert the website address specified by the lieutenant governor].CITIZENSHIP AFFIDAVITName:Name at birth, if different:Place of birth:Date of birth:Date and place of naturalization (if applicable):I hereby swear and affirm, under penalties for voting fraud set forth below, that I am a citizen and that to the best of my knowledge and belief the information above is true and correct.____________________________Signature of ApplicantIn accordance with Section 20A-2-401, the penalty for willfully causing, procuring, or allowing yourself to be registered or preregistered to vote if you know you are not entitled to register or preregister to vote is up to one year in jail and a fine of up to $2,500.NOTICE: IN ORDER TO BE ALLOWED TO VOTE, YOU MUST PRESENT VALID VOTER IDENTIFICATION TO THE POLL WORKER, IN ACCORDANCE WITH THE REQUIREMENTS OF LAW.FOR OFFICIAL USE ONLYType of I.D. ____________________________Voting Precinct _________________________Voting I.D. Number _____________________------------------------------------------------------------------------------------------------------------------" (b) The voter registration form described in Subsection (1)(a) shall include: (i) a section in substantially the following form:"------------------------------------------------------------------------------------------------------------------BALLOT NOTIFICATIONSDo you consent to receive communications about the status of your ballot and other official communications, by text, at the phone number you provided above? Yes No ------------------------------------------------------------------------------------------------------------------"; and (ii) the following, immediately after the question described in Subsection (1)(b)(i):"Indicate below how you want to vote in upcoming elections:_____ Mail a ballot to me._____ Do not mail a ballot to me. I will vote in person." (c) The back of the voter registration form shall include the following statement:"Proof of United States citizenship may be established by one of the following methods: a Utah driver license number that verifies United States citizenship; a Utah state identification card number that verifies United States citizenship; a legible copy of your birth certificate that verifies United States citizenship; a legible copy of the pages of a United States passport that identifies you and your passport number; an alien registration number that verifies United States citizenship; a legible copy of your United States naturalization documents; a Bureau of Indian Affairs card number, tribal treaty card number, or tribal enrollment number; a legible copy of a certificate of degree of Indian blood or a Bureau of Indian Affairs affidavit of birth; verification of citizenship from the Systematic Alien Verification for Entitlements program, operated by the United States Department of Homeland Security; or other documents or methods of proving United States citizenship that are established in accordance with the Immigration Reform and Control Act of 1986." (2) When political parties not listed on the voter registration form qualify as registered political parties under Chapter 8, Political Party Formation and Procedures, the lieutenant governor shall inform the county clerks of the name of the new political party and direct the county clerks to ensure that the voter registration form is modified to include that political party. (3) Upon receipt of a voter registration form from an applicant, the county clerk or the clerk's designee shall: (a) review each voter registration form for completeness and accuracy; and (b) if the county clerk believes, based upon a review of the form, that an individual may be seeking to register or preregister to vote who is not legally entitled to register or preregister to vote, refer the form to the county attorney for investigation and possible prosecution. (4) An individual who registers to vote using a federal voter registration form is limited to voting a federal ballot, unless the individual provides documentary proof of United States citizenship.