Tennessee Code 2-2-116 – Registration form

The permanent registration record shall be substantially as follows, shall contain all the information required before being signed by the registrant, and shall be witnessed as indicated on the form.

PERMANENT REGISTRATION RECORD

1. ______________

Last Name First Name Middle Name Sex

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Terms Used In Tennessee Code 2-2-116

Answer: The formal written statement by a defendant responding to a civil complaint and setting forth the grounds for defense.
Conviction: A judgement of guilt against a criminal defendant.
Person: includes a corporation, firm, company or association. See Tennessee Code 1-3-105
Record: means information that is inscribed on a tangible medium or that is stored in an electronic or other medium and is retrievable in a perceivable form. See Tennessee Code 1-3-105
Road: includes public bridges and may be held equivalent to the words "county way" "county road" or "state road". See Tennessee Code 1-3-105
signed: includes a mark, the name being written near the mark and witnessed, or any other symbol or methodology executed or adopted by a party with intention to authenticate a writing or record, regardless of being witnessed. See Tennessee Code 1-3-105
State: when applied to the different parts of the United States, includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105

2. Legal Residence ______________

Number Street or Road Apt.

3. City ____________________ County ______________

4. Mailing Address if different from Legal Residence.

______________

5. Social Security number, if any ______________

6. Date and place of birth ______________

7. Are you a citizen of the United States? ______________

8. Where were you last registered to vote? City ____________________ County ____________________ State ______________

9. Are you a resident of the State of Tennessee? ______________

10. Have you ever been convicted of a crime which is a felony in this state, by a court in this state, a court in another state, or a federal court?

______________

11. If the answer to question ten (10) is “yes,” list the crime, or crimes, for which you were convicted, and date, or dates, of conviction. ______________

12. If the answer to question ten (10) is “yes,” have you received a pardon or had your full rights of citizenship restored by a court for all crimes listed?

______________

State of Tennessee

County of

I, being duly sworn on oath (or affirmation) declare that the above address is my legal residence and that I plan to remain at such residence for an undetermined period of time and say that to the best of my knowledge and belief all of the foregoing statements made by me are true.

____________________

Signature of Applicant

If the registrant signs by a mark, or cannot sign at all, fill in the following information:

Sworn to and subscribed to before me

this ____________________ day of ____________________, 20 ____________________,

____________________ ____________________

Signature of Administrator of Elections or

other person taking affidavit

______________

Official Position

Registered as voter in District ____________________ Ward ____________________

Precinct ____________________ effective ____________________.