**  Name: Applicants must give their full legal name. A married woman may not use her husband’s first name in place of her own.

**  Residence Address: The street address of the applicant must be in Galveston County and appear in the space. If none, describe where you live. DO NOT USE A POST OFFICE BOX OR A RURAL ROUTE.

Mailing Address: If you cannot receive mail at the above address, a separate mailing address may be given.

Gender: Optional.

** Date of Birth: The date of birthday field must be completed with the month, day and year of birth.

County of Address of Former Residence: Applicants must indicate if they were formerly registered in another Texas county. The Voter Registrar will cancel a previous registration to prevent a duplicate registration in more than one county.

** United States Citizen: The applicant must be a U.S. citizen to become a registered voter. The corresponding box must be checked.

** Social Security Number:  The Social Security number is used to accurately maintain the voter registration records.

** Texas Drivers License Number:

Telephone Number: Optional. The telephone number is used only to verify information with the applicant, if needed.

Date: The date the voter has completed and signed the voter registration application.

** Signature of Applicant or Agent: A signature of applicant or Agent is required on all applications. A husband, wife, mother, father, son or daughter may act as an agent to register one another with the voter’s consent. If a person is unable to sign the application, have them make a mark in the appropriate space, witness their "mark" with your signature.

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