2023 Tennessee Code
Title 2 - ELECTIONS (§§ 2-1-101 — 2-20-109)
Chapter 2 - VOTER REGISTRATION (§§ 2-2-101 — 2-2-303)
Part 1 - REGISTRATION BY ELECTION COMMISSIONS (§§ 2-2-101 — 2-2-143)
Section 2-2-116 - Registration form

The permanent registration record shall be substantially as follows, shall contain all the information required before being signed by the registrant, and shall be witnessed as indicated on the form.

PERMANENT REGISTRATION RECORD

• 1. ______________

  Last Name First Name Middle Name Sex

• 2. Legal Residence ______________

  Number Street or Road Apt.

• 3. City ____________________ County ______________

• 4. Mailing Address if different from Legal Residence.

  ______________

• 5. Social Security number, if any ______________

• 6. Date and place of birth ______________

• 7. Are you a citizen of the United States? ______________

• 8. Where were you last registered to vote? City ____________________ County ____________________ State ______________

• 9. Are you a resident of the State of Tennessee? ______________

• 10. Have you ever been convicted of a crime which is a felony in this state, by a court in this state, a court in another state, or a federal court?

  ______________

• 11. If the answer to question ten (10) is "yes," list the crime, or crimes, for which you were convicted, and date, or dates, of conviction. ______________

• 12. If the answer to question ten (10) is "yes," have you received a pardon or had your full rights of citizenship restored by a court for all crimes listed?

  ______________

  State of Tennessee

  ss

  County of

  I, being duly sworn on oath (or affirmation) declare that the above address is my legal residence and that I plan to remain at such residence for an undetermined period of time and say that to the best of my knowledge and belief all of the foregoing statements made by me are true.

  ____________________

  Signature of Applicant

  If the registrant signs by a mark, or cannot sign at all, fill in the following information:

  Sworn to and subscribed to before me

  this ____________________ day of ____________________, 20 ____________________,

  ____________________ ____________________

  Signature of Administrator of Elections or

  other person taking affidavit

  ______________

  Official Position

  Registered as voter in District ____________________ Ward ____________________

  Precinct ____________________ effective ____________________.

Acts 1972, ch. 740, § 1; 1978, ch. 941, § 3; T.C.A., § 2-216; Acts 1981, ch. 337, § 1; 1981, ch. 345, § 5; 1989, ch. 274, § 2; 1994, ch. 919, §§ 13-15; 2001, ch. 413, § 12; 2002, ch. 698, § 4; 2008 , ch. 928, § 2.