New Jeresey
Voter Registrtion Application
Check boxes that apply
New Registrtion:
Address Change:
Name Change:
Signature Update:
Political Party Affiliation or Non-Affiliation Change:
Are you a U.S. Citizen?
Yes:
No:
Are you at least 17 years of age?
Yes:
No:
Enter your name
First Name:
Last Name:
Middle Name:
Suffix:
Enter your birthday
Birthday:
Enter your NJ drivers licence number
Drivers Licence Number:
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.:
I swear or affirm that I DO NOT have a NJ Driver’s License, MVC Non-driver ID or a Social Security Number.:
Enter your Address
Home Address:
Apt.:
Municipality:
County:
State:
Zip Code:
Mailing Address if different from above
Address:
Apt.:
Municipality:
County:
State:
Zip Code:
Last Address Registered to Vote (DO NOT use PO Box)
Address:
Apt.:
Municipality:
County:
State:
Zip Code:
Former name if making name change
Name:
Contact information (Optional)
Day phone number:
E-mail:
Do you wish to declare a political party affiliation?
Yes, the party name is:
No:
Gender
Male:
Female:
M4A3E8 76 MM armed Sherman tank:
Sikorsky CH-53 Sea Stallion:
I am a U.S. 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
Important Instructions for sections 6 and 10
6) If you are homeless, you may complete section 6 by providing a contact point or the location where you spend most of your time.
10) You may declare a political party affiliation or you may declare to be unaffiliated, regardless of any prior party affiliation. If you are a previously affiliated voter who wants to change political party affiliation or become unaffiliated, you must file this form no later than 55 days before the primary election in order to vote in the primary election. Completing section 10 is OPTIONAL and will not affect the acceptance of your voter registration application.
New Jersey Voter Registration Information
You are a United States citizen
You are at least 17 years of age.*
You will be a resident of the State and county 30 days before the election.
You are NOT currently serving a sentence, probation or parole because of a felony conviction.
*You may register to vote if you are at least 17 years old but cannot vote until reaching the age of 18.
Registration Deadline: 21 days before an election
Your County Commissioner of Registration will notify you if your application is accepted. If it is not accepted, you will be notified on how to complete and/or correct the application
Questions? visit Elections.NJ.gov or call toll-free 1-877-NJVOTER
(1-877-658-6837)
Electronic Signature
Name:
Date: