SIDE A
OFFICE OF THE SECRETARY OF STATE
APPLICATION FOR ISSUANCE OF FREE ALABAMA BIRTH OR MARRIAGE
CERTIFICATION TO OBTAIN FREE ALABAMA PHOTO VOTER ID CARD
Print Your Name: ________________________________________________
Address: _______________________________________________________
City: __________________________ State: _________________________
Zip: _________________ Daytime Phone:( ______) ____________________
DO NOT COMPLETE THIS FORM IF YOU HAVE ANY OF THE FOLLOWING:
I, ________________________________, a registered voter in the State of Alabama, do hereby swear or affirm that I do not possess any of the forms of photo ID listed above. I further swear or affirm that the information contained on this form (Side A and Side B) is true and correct. I understand that the free birth or marriage certificate will be issued electronically to the processing or issuing agent and that said free certification cannot be used for any purpose other than obtaining a free Alabama photo voter ID card.
Signature of Alabama registered voter ______________________ Date __________
SIDE B
APPLICATION FOR ISSUANCE OF A FREE ALABAMA BIRTH OR MARRIAGE CERTIFICATION TO OBTAIN FREE ALABAMA PHOTO VOTER ID CARD
SIDE A MUST BE COMPLETED BEFORE COMPLETING SIDE B OF THIS FORM
USE ONLY FOR A VITAL EVENT WHICH OCCURRED IN ALABAMA
Ala. Admin. Code r. 820-2-9-.13
Authors: Jean Brown, William Sutton
Statutory Authority: Code of Ala. 1975, § 17-9-30 (2011).