Voter Registration Instructions - Iowa

These are the specific instructions for using this form to register to vote in Iowa.

Attention: Proof of Voter Identification (Pursuant to the Help America Vote Act of 2002) If you submit this form by mail and you are
registering to vote for the first time in this county enclose a COPY of one of the following documents: A) current and valid photo
identification card showing your name or B) current utility bill, bank statement, government check, paycheck or government document
showing your name and address. If you do not provide proof of identification, you may cast a provisional ballot. You do not need to send
any of the documents listed above if you include your drivers license number or the last 4 digits of your social security number and this
information can be verified.

Terrell

Andre

415 E. 13th St.

Davenport

IA

52803

321 W. Locust

IA

05

19

1976

5633240534

609YY70366566

Elections Division, Office of Secretary of State

Lucas Bldg., 1st Fl., 321 E. 12th St.

Des Moines,

IA

50319

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