Tenn. Code Ann. § 2-2-116

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 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 ss 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 ____________________. 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.
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
Last Name First Name Middle Name Sex
2. Legal Residence ______________ Number Street or Road Apt.
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
. 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 ss 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 ____________________.
______________
State of Tennessee
ss
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 ____________________.
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.