Voter Registration Verification Request Form

Supervisor of Elections
Brevard County, Florida

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Voter Registration Verification Request Form

If you are uncertain about the status of your Brevard County, Florida, voter registration, the form below can be used to request verification of your status. Please fill out the form as completely as possible to ensure that we verify the registration of the correct person. Use the Tab key, not the Enter key, to move from field to field on the form below. Once you have completed the form, press the "Submit Query" button. A response will be e-mailed to you within a few days. If you have any questions about this form, please e-mail us at lwhite@brevardelections.org.

Name:

Date of birth:

Voter registration number (if known):

Phone number:

E-mail address (required):

NOTE: If you do not have an e-mail address, instead of submitting this form please contact our office by phone to verify your registration status.

Brevard County residence address:

Check if you do not have a permanent residence address in Brevard County and are living outside of the county but intend to remain a permanent resident of the county. (If this applies to you, do not enter an address in the space above)

Old Brevard County residence address (if you have changed your address since the last time you voted or contacted our office):

Mailing address (if different from residence address):

Old mailing address (if your mailing address has changed):

Additional comments:

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