§ RSMo § 115.155Registration — application — oath — transfer of data to election authority — documents, preservation of

1. The election authority shall provide for the registration of each voter. Each application shall be in substantially the following form: ­ APPLICATION FOR REGISTRATION Are you a citizen of the United States? ☐ YES ☐ NO Will you be 18 years of age on or before election day? ☐ YES ☐ NO IF YOU CHECKED “NO” IN RESPONSE TO EITHER OF THESE QUESTIONS, DO NOT COMPLETE THIS FORM. IF YOU ARE SUBMITTING THIS FORM BY MAIL AND ARE REGISTERING FOR THE FIRST TIME, PLEASE SUBMIT A COPY OF A CURRENT, VALID PHOTO IDENTIFICATION. IF YOU DO NOT SUBMIT SUCH INFORMATION, YOU WILL BE REQUIRED TO PRESENT ADDITIONAL IDENTIFICATION UPON VOTING FOR THE FIRST TIME SUCH AS A BIRTH CERTIFICATE, A NATIVE AMERICAN TRIBAL DOCUMENT, OTHER PROOF OF UNITED STATES CITIZENSHIP, A VALID MISSOURI DRIVER'S LICENSE OR OTHER FORM OF PERSONAL IDENTIFICATION. _______________________ Township (or Ward) _______________________ Name _______________________ Precinct _______________________ Home Address _______________________ Required Personal Identification Information _______________________ City ZIP _______________________ Date of Birth _______________________ Place of Birth (Optional) _______________________ Telephone Number (Optional) _______________________ Mother's Maiden Name (Optional) _______________________ Occupation (Optional) _______________________ Last Place Previously Registered _______________________ Last four digits of Social Security Number (Required for registration unless no Social Security Number exists for Applicant) _______________________ Under What Name _______________________ When Remarks: Political Party Affiliation (OPTIONAL: You shall be unaffiliated unless you designate an affiliation.) I am a citizen of the United States and a resident of the state of Missouri. I have not been adjudged incapacitated by any court of law. If I have been convicted of a felony or of a misdemeanor connected with the right of suffrage, I have had the voting disabilities resulting from such conviction removed pursuant to law. I do solemnly swear that all statements made on this card are true to the best of my knowledge and belief. I UNDERSTAND THAT IF I REGISTER TO VOTE KNOWING THAT I AM NOT LEGALLY ENTITLED TO REGISTER, I AM COMMITTING A CLASS ONE ELECTION OFFENSE AND MAY BE PUNISHED BY IMPRISONMENT OF NOT MORE THAN FIVE YEARS OR BY A FINE OF BETWEEN TWO THOUSAND FIVE HUNDRED DOLLARS AND TEN THOUSAND DOLLARS OR BY BOTH SUCH IMPRISONMENT AND FINE. _______________________ Signature of Voter _______________________ Date _______________________ Signature of Election Official