Voter Registration Application
NEW Jersey State seal

Check boxes that apply:
New Registration
Name Change
Address Change
Signature Update
Political Party Affiliation or Non-Affiliation Change

Are you a U.S. Cititizen?

(If No, DO NOT complete this form)

Yes
No

Are you atleast 17 years of age?

(If No, DO NOT complete this form)

Yes
No


Last Name:
First Name:

Middle Initial or Initial:
 Suffix:

Date of Birth:
MALE
FEMALE


New Jersey Driver's License Number or Non-driver ID Number

 Driver's License #:

If you DO NOT have a Driver's License,provide the 4 digits of your social security

No ID

Home Address

Zip Code

State