2150.
(a) The affidavit of registration shall show:(1) The facts necessary to establish the affiant as an elector.
(2) The affiant’s name at length, including his or her given name, and a middle name or initial, or if the initial of the given name is customarily used, then the initial and middle name. The affiant’s given name may be preceded, at affiant’s option, by the designation of Miss, Ms., Mrs., or Mr. A person shall not be denied the right to register because of his or her failure to mark a prefix to the given name and shall be so advised on the voter registration card. This subdivision shall not be construed as
requiring the printing of prefixes on an affidavit of registration.
(3) The affiant’s place of residence, residence telephone number, if furnished, and e-mail address, if furnished. No person shall be denied the right to register because of his or her failure to furnish a telephone number or e-mail address, and shall be so advised on the voter registration card.
(4) The affiant’s mailing address, if different from the place of residence.
(5) The affiant’s date of birth to establish that he or she will be at least 18 years of age on or before the date of the next election. In the case of an affidavit of registration submitted pursuant to subdivision (d) of Section 2102, the affiant’s date of birth to establish that he or she is at least 17 years of age.
(6) The state or country of the affiant’s birth.
(7) (A) In the case of an applicant who has been issued a current and valid driver’s license, the applicant’s driver’s license number.
(B) In the case of any other applicant, other than an applicant to whom subparagraph (C) applies, the last four digits of the applicant’s social security number.
(C) If an applicant for voter registration has not been issued a current and valid driver’s license or a social security number, the state shall assign the applicant a number that will serve to identify the applicant for voter registration purposes. To the extent that the state has a computerized list in effect under this subdivision and the list assigns unique identifying numbers to
registrants, the number assigned under this subparagraph shall be the unique identifying number assigned under the list.
(8) The affiant’s political party affiliation.
(9) That the affiant is currently not imprisoned or on parole for the conviction of a felony.
(10) A prior registration portion indicating whether the affiant has been registered at another address, under another name, or as intending to affiliate with another party. If the affiant has been so registered, he or she shall give an additional statement giving that address, name, or party.
(b) The affiant shall certify the content of the affidavit as to its truth and correctness, under penalty of perjury, with the signature of his or her name and the date of signing. If the affiant is unable
to write he or she shall sign with a mark or cross.
(c) The affidavit of registration shall also contain a space that would enable the affiant to state his or her ethnicity or race, or both. An affiant may not be denied the ability to register because he or she declines to state his or her ethnicity or race.
(d) If a person, including a deputy registrar, assists the affiant in completing the affidavit, that person shall sign and date the affidavit below the signature of the affiant.
(e) The affidavit of registration shall also contain a space to permit the affiant to apply for permanent vote by mail status.
(f) The Secretary of State may continue to supply existing affidavits of registration to county elections officials prior to printing new or revised
forms that reflect the changes made to this section by the act that added this subdivision.