New Jersey Voter Registration Application

Check boxes that apply:
New Registration Name Change
PoLITical Party Address Change
Signature Update
Are you a U.S. Citizen? Yes NO Are you at least 17 years of age? Yes NO
Last Name
First Name
 Middle Name or Initial
Suffix
Date of Birth
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NJ Driver's License or MVC Non-driver ID Number
If you do not have an ID please provide the last four digits of your Social Security Number:
Home Address (DO NOT USE PO BOX)
Apt.
Municipality
County
State
Zip
Mailing Address (If Different from above)
Apt.
Municipality
County
State
Zip
Last Address Registered to Vote (DO NOT USE PO BOX)
Apt.
Municipality
County
State
Zip
Former Name if Making Name Change
Day Phone Number (Optional)
Email Address (Optional)
Do You wish to declare a PoLITicalparty? Yes! The name of the party is: No I do not want to be LIT at this time.
Gender Male
Female
Other