2023 Tennessee Code 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
Last Name First Name Middle Name Sex
Number Street or Road Apt.
______________
City ___________County ___________ State ______________
______________
______________
______________
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 ____________.