Board of Election Commissioners, Clay County, MO

CLAY COUNTY VOTER NAME AND ADDRESS CHANGE FORM:

Address Change

Name Change

Both

Last Name:

First Name:

M.I.

Suffix:

Former Name:

Date of Birth:

New Address:

(Street Address)	(City)	(Zip)

Previous Address:

(Street Address)	(City)	(Zip)

Mailing Address, If Different:

Day Phone #:

Last 4 Digits of SS #:

______________________________________________________________________________

SIGNATURE DATE

Print this page, SIGN and date the form, and fax this page to (816) 792-5334 or mail the entire page in a stamped envelope to:

Clay County
Board of Election Commissioners
100 W. Mississippi St.
Liberty, MO 64068

If your residence is within Clay County , we will process your information change and mail you a new Voter Card. If you have moved out of Clay County , we will cancel your Clay County voter registration and you must apply for new voter registration in the county or state where you now live.

This form cannot be used to apply for NEW voter registration. It may ONLY BE USED TO MAKE CHANGES TO YOUR CLAY COUNTY VOTER REGISTRATION IF YOU ARE ALREADY REGISTERED IN CLAY COUNTY. Call the Board of Elections office at 415-8683 if you do not know whether or not you are already a registered voter in Clay County.