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 RECORD1. ______________ Last Name First Name Middle Name Sex2. 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. 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 TennesseessCounty ofI, 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 ApplicantIf the registrant signs by a mark, or cannot sign at all, fill in the following information:Sworn to and subscribed to before methis ____________________ day of ____________________, 20 ____________________,____________________ ____________________Signature of Administrator of Elections orother person taking affidavit______________Official PositionRegistered as voter in District ____________________ Ward ____________________Precinct ____________________ effective trator of Elections orother person taking affidavit______________Official PositionRegistered as voter in District ____________________ Ward ____________________Precinct ____________________ effective ____________________.Acts 1972, ch. 740, § 1; 1978, ch. 941, § 3; T.C.A., § 2-216; Acts 1981, ch. 337, § 1; 1981, ch. 345, § 5; 1989, ch. 274, § 2; 1994, ch. 919, §§ 13-15; 2001, ch. 413, § 12; 2002, ch. 698, § 4; 2008 , ch. 928, § 2.
Tennessee Legal Code