§104. Application for registration; form

            A. The secretary of state, subject to approval by the attorney general as to content, shall prescribe the form that shall be used uniformly by each registrar in the state and any person authorized to accept voter registration applications in registering qualified citizens to vote. The form shall contain spaces for at least the following required information to be provided by the applicant for the registrar of voters to assess eligibility:

            (1) Date of application.

            (2) Name.

            (3) Date of birth.

            (4) Place of residence, including street or apartment number or both, municipality (if any), and if a rural address, sufficient information, in addition to route and post box number, to identify the precinct of residence, and mailing address.

            (5) Louisiana driver's license number or Louisiana special identification card number, if issued, or if no Louisiana driver's license or Louisiana special identification card has been issued, the last four digits of the social security number, if issued. The full social security number of the applicant may be provided on a voluntary basis by the applicant. If the applicant has neither a Louisiana driver's license, a Louisiana special identification card, or a social security number, the applicant shall attach one of the following items to his application:

            (a) A copy of a current and valid photo identification.

            (b) A copy of a current utility bill, bank statement, government check, paycheck, or other government document that shows the name and address of the applicant.

            B. The form shall also contain spaces for the following additional information to be provided by the applicant with the initial application or in response to a request for additional information by the registrar of voters for clear and sufficient identification of the applicant as the person he claims to be and subsequently for his identification at the polls:

            (1) Sex.

            (2) Race or ethnic origin, which shall at least include Hispanic, American Indian, Asian, and other as choices.

            (3) A single political party affiliation or, if none, an entry to that effect.

            (4) Place of birth.

            (5) Mother's maiden name.

            (6) Electronic mail address.

            (7) Telephone number.

            (8) Whether the applicant requires assistance when he votes, and if so, the reason therefor. If the person is unable to read or write English, the form shall show in which language he is entitled to printed materials and ballots and assistance if his language is one of a minority language group as determined pursuant to the federal Voting Rights Act.

            (9) Last residence address.

            (10) Place of last registration.

            (11) Former registered name, if applicable.

            C.(1) The form shall inform the applicant of the penalty for violation of applicable laws relating to registration of voters and shall contain an affidavit to be subscribed, through a handwritten signature, attesting to each of the following:

            (a) That the applicant is a United States citizen.

            (b) That the applicant is not currently under an order of imprisonment for conviction of a felony or, if the applicant is under such an order, that the applicant has not been incarcerated pursuant to the order within the last five years and he is not under an order of imprisonment related to a felony conviction pursuant to election fraud or any other election offense pursuant to R.S. 18:1461.2.

            (c) That the applicant is not currently under a judgment of full interdiction for mental incompetence, or a limited interdiction in which the right to register to vote has specifically been suspended.

            (d) That the facts given by him on the application are true to the best of his knowledge and belief.

            (2) If the applicant is unable to write, the applicant shall affix his mark to the application in the presence of two witnesses who shall also sign their names as witnesses to the mark.

            (3) When the registration application is completed at the office of motor vehicles of the Department of Public Safety and Corrections or electronically on the secretary of state's website, an electronically captured signature of the applicant shall suffice as a handwritten signature of the applicant.

            D. The form shall include the questions "Are you a citizen of the United States of America?" and "Will you be 18 years of age on or before election day?" and the statement "If you checked 'no' in response to either of these questions, do not complete the form.".

            E. In no event shall information with respect to race or ethnic origin be required for registration. However, such information may be given voluntarily by the applicant for registration and a registrar may keep statistics with respect to race and ethnic origin.

            F. Upon request, the registrar shall furnish each applicant a copy of his application form without redaction, and the applicant shall be informed that he may obtain such copy.

            G. The secretary of state may require such reasonable additional information as he deems necessary for the effective registration of voters.

            H. No voter registration application form except that prescribed by the secretary of state shall be used by any registrar.

            I. The secretary of state may remove any spaces for information on the form required by this Section if such requirement does not receive preclearance pursuant to the Voting Rights Act of 1965.

            J. No voter registration application shall be complete unless the applicant provides one of the forms of identification provided for in Paragraph (A)(5) of this Section.

            Acts 1976, No. 697, §1, eff. Jan. 1, 1978. Amended by Acts 1977, No. 544, §1, eff. Jan. 1, 1978; Acts 1979, No. 446, §1; Acts 1981, No. 77, §1, eff. June 26, 1981; Acts 1983, No. 519, §1, eff. July 8, 1983; Acts 1988, No. 909, §1, eff. Jan. 1, 1989; Acts 1991, No. 201, §2, eff. Jan. 1, 1992; Acts 1994, 3rd Ex. Sess., No. 10, §1, eff. Jan. 1, 1995; Acts 2001, No. 451, §6, eff. Jan. 12, 2004; Acts 2001, No. 1032, §7; Acts 2003, No. 1022, §1; Acts 2003, No. 1220, §2, eff. July 3, 2003; Acts 2004, No. 575, §1, eff. Jan. 1, 2005; Acts 2006, No. 403, §1, eff. June 15, 2006; Acts 2009, No. 187, §1, eff. April 1, 2010; Acts 2012, No. 138, §1, eff. May 14, 2012; Acts 2014, No. 60, §1, eff. May 16, 2014; Acts 2017, No. 176, §2, eff. Jan. 1, 2018; Acts 2018, No. 636, §1, eff. March 1, 2019; Acts 2019, No. 374, §2, eff. Jan. 1, 2020; Acts 2023, No. 91, §1, eff. June 6, 2023.