Application forms — Vermont Code § 2145

§ 2145. Application forms

• (a) The voter registration application shall be in the form approved by the Federal Election
  Commission or by the Secretary of State. The application form approved by the Secretary
  shall include: (1) A place for the applicant to swear or affirm, by checking the appropriate box, that
  he or she meets all voter eligibility requirements set forth in section 2121 of this title and a place for the signature of the applicant affirming, under penalty of perjury,
  that all information submitted by the applicant is accurate and truthful. The affirmation
  shall include the following information: (A) The applicant’s place and date of birth. (B) The applicant’s town of legal residence. (C) The applicant’s street address or a description of the physical location of the applicant’s
  residence. The description must contain sufficient information so that the town clerk
  can determine whether the applicant is a resident of the town. (D)(i) If the applicant has been issued a current and valid driver’s license or nondriver’s
  identification, the applicant’s driver’s license number or nondriver’s identification
  number; (ii) If the applicant does not possess a driver’s license number, the last four digits
  of the applicant’s Social Security number; or (iii) If the applicant does not possess a Social Security number, the town clerk shall contact
  the Secretary of State and the Secretary shall assign a unique identifier for the
  applicant. (E) The applicant’s email address, which shall be optional to provide. (2) The voter’s oath. (3) Space for the town clerk to document action on the application. (4) The following statements: (A) “If you were provided with this application form by a voter registration agency, you
  may decline to register. If you decline to register, your failure to register will
  remain confidential and will be used only for voter registration purposes.” (B) “If you are submitting this application through a voter registration agency, the office
  through which you submitted this application will remain confidential and will be
  used only for voter registration purposes.” (5) [Repealed.] (b) [Repealed.] (c) A board of civil authority or town clerk may not require a person to complete any
  form other than that approved under subsection (a) of this section or section 2145a of this title; nor may the board of civil authority or the town clerk require all applicants or
  any particular class or group of applicants to appear personally before a meeting
  of the board or routinely or as a matter of policy require applicants to submit additional
  information to verify or otherwise support the information contained in the application
  form. (d) When the board of civil authority acts on an application to add a name to the checklist,
  it or, upon request of the board, the town clerk shall notify the applicant by returning
  one copy of the completed application to the applicant and shall notify the town in
  which the applicant was last registered to vote, whether within or without the State
  of Vermont, by submitting the notification electronically within the statewide voter
  checklist system or by mailing a copy of the completed application to that town before
  adding the applicant’s name and mailing address to the checklist. The original application
  shall be filed in the office of the town clerk. (e) The Secretary of State shall provide each town clerk and voter registration agency
  with a sufficient number of forms at State expense. (f) A person who makes a false statement in completing a voter registration application
  form or the voter registration portion of an application for a motor vehicle driver’s
  license or nondriver identification card or of an application for the services of
  a designated automatic voter registration agency knowing the statement to be false
  shall be subject to the penalties of perjury as provided in 13 V.S.A. § 2901, except that a person who is not eligible to register to vote and who otherwise completes
  the application accurately shall not be considered to have made a false statement
  under this subsection by his or her unintentional failure to decline to register on
  a motor vehicle driver’s license or nondriver identification card application under
  section 2145a of this chapter or on a designated automatic voter registration agency’s
  application under subsection 2145b(e) of this chapter. (g) A voter who moves from one address in a town in which that voter is registered to
  another address in the same town, or whose name has been changed, shall not be required
  to reapply as provided in this section, but shall notify the town clerk of his or
  her new name or address, unless such information has been provided to the Department
  of Motor Vehicles or a voter registration agency, so that the voter’s name may be
  changed or transferred, if necessary, to the proper subdivision of the checklist.
  The voter registration application form may be used to notify the clerk or the board
  that the voter has changed his or her name or address. (Added 1977, No. 269 (Adj. Sess.), § 1; amended 1981, No. 239 (Adj. Sess.), § 10; 1997, No. 47, § 4; 2001, No. 7, § 1, eff. Jan. 1, 2002; 2003, No. 59, § 4; 2013, No. 161 (Adj. Sess.), § 3; 2015, No. 44, § 4, eff. Jan. 1, 2017; 2015, No. 80 (Adj. Sess.), § 2, eff. July 1, 2017; 2019, No. 67, § 5a.)