New Jersey Voter Registration Application

All information is required unless marked optional

1. Form Purpose: check all that apply

New Registration
Address Change
Party Affiliation Change
Name Change
Signature Update

2. Are you a US Citizen (If No, DO NOT complete form): Yes No

3. Are you at least 17 years of age (if No, DO NOT complete form): Yes No

4. Full Legal Name:

5. Date of Birth:

6. Gender: Male Female

NJ Driver's License or MVC Non-Driver ID#:

Alternative ID: If you DO NOT have a NJ Driver’s License or MVC Non-Driver ID, provide the last 4 digits of your Social Security Number.

No ID Declaration: “I swear or affirm that I DO NOT have a NJ Driver’s License, MVC Non-driver ID or a Social Security Number.”

Home Address (PO Box Invalid):

Mailing Address (IF different than HOME):

Last Address Registered to Vote:

For registering a name change, provide your former name:

Email Address (optional): Phone Number (optional):

Political Party Affiliation: Declare Affiliation: No Affiliation

Declaration and Signature:

I swear or affirm that:

I am a US Citizen
I live at the above address
I am at least 17 years old, and understand that I may not vote until reaching the age of 18
I will have resided in the State and county at least 30 days before the next election
I am not on parole, probation or serving a sentence due to a conviction for an indictable offense under any federal or state laws
I understand that any false or fraudulent registration may subject me to a fine of up to $15,000, imprisonment up to 5 years, or both pursuant to R.S. 19:34-1

I, the applicant for this voter registration form, warrant the truthfulness of the information provided in this application. I understand that checking this box constitutes a legal signature, confirming that I meet the above affirmations and guarantee the full validity and legality of all information entered in this form.

Check boxes below if you would like to receive more information about:

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