Alabama Administrative Code › Title 820 - STATE OF ALABAMA OFFICE OF THE SECRETARY OF STATE › Chapter 820-2-2 - VOTER REGISTRATION › Section 820-2-2-.23 - Agency-Based Voter Registration Form

Current through Register Vol. 42, No. 9, June 28, 2024
(a) Pursuant to  52 U.S.C. 20504, the
			 following form shall be used in all offices in the State that issue driver's
			 licenses and nondriver's identification cards and all state-designated voter
			 registration agencies designated in Rule 820-2-2-.03.
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AFFIDAVIT AND APPLICATION FOR A CERTIFICATION OF AN ALABAMA
				BIRTH RECORD FOR ALABAMA VOTER REGISTRATION USE
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APPLICATION TO THE COUNTY BOARD OF REGISTRARS FOR HEARING
				TO DETERMINE APPLICANT'S CITIZENSHIP FOR VOTING PURPOSES (Form
				C-4)
Complete and submit only if applicant has not submitted
				satisfactory documentary proof of citizenship.
I, __________, hereby request a hearing with the county Board
				of Registrars. In support thereof, I affirm as follows:
I am a United States citizen but do not possess or have access
				to any of the following documents showing United States Citizenship:
(1) A driver's license or nondriver's
			 identification card issued by the division of motor vehicles or the equivalent
			 governmental agency of any state within the United States provided that the
			 governmental agency of another state within the U.S. requires proof of lawful
			 presence (i.e., U.S. citizenship) in the U.S. as a condition of issuance of the
			 driver's license or nondriver's identification card.
Alabama driver's
			 license or nondriver's ID card must be a "Star" license or ID.
(2) A birth certificate indicating birth in
			 the U.S. or one of its territories.
(3) Pertinent pages of a valid or expired
			 passport identifying me and my passport number, or presentation of my U.S.
			 passport.
(4) United States
			 naturalization documents or the number of the certificate of
			 naturalization.
(5) Other documents
			 or methods of proof of United States citizenship issued by the federal
			 government pursuant to the Immigration and Nationality Act of 1952, and
			 amendments thereto.
(6) A Bureau of
			 Indian Affairs card number, tribal treaty card number, or tribal enrollment
			 number.
(7) A consular report of
			 birth abroad of a citizen of the United States of America.
(8) A certificate of citizenship issued by
			 the United States Citizenship and Immigration Services.
(9) A certification of report of birth issued
			 by the United States Department of State.
(10) An American Indian card, with KIC
			 classification, issued by the United States Department of Homeland
			 Security.
(11) A final adoption
			 decree showing my name and United States birthplace.
(12) An official United States military
			 record of service showing my place of birth in the United States.
(13) An extract from a United States hospital
			 record of birth created at the time of my birth indicating my place of birth in
			 the United States.
(14) Federal
			 confirmation of U.S. citizenship under  8 U.S.C. §
										1373.
I believe that I am a United States citizen based upon the
				following information:
(Provide the details as to why or how you became a
				citizen of the United States.)
I submit herewith the following documentation that proves that
				I am a United States citizen:
(Attach copies of any documentation that you believe
				demonstrates citizenship, such as newspaper birth announcements, family Bible
				entries, certificate of foreign birth if it reflects U.S. citizenship,
				affidavits signed by three U.S. citizens who know you are a U.S. citizen and
				have known you for 10 years or more, etc.)
NOTICE OF RIGHT TO HEARING BEFORE THE COUNTY BOARD OF
				REGISTRARS
I understand that I am entitled to a hearing before the Board
				of Registrars and an opportunity to testify and to present witnesses and
				additional evidence of citizenship if the Board does not determine that I have
				provided satisfactory evidence of citizenship based upon the information that I
				have supplied above. I understand that I have the right to have counsel,
				provided at my own expense, present at said hearing. I understand that notice
				of the hearing will be mailed to the address that I have provided at least five
				days prior to the hearing date.
_____________________
Signature of applicant
Mail completed form and attached documents to your local Board
				of Registrars.