New Jersey

Voter Registration Application

1 Check boxes that apply
2 Are you a U.S. Citizen? Are you at least 17 years of age? If no, DO NOT complete this form
3 Last Name First Name Middle Name or Initial Suffix (Jr., Sr., III)
4 Date of Birth
5 NJ Driver's License Number or MVC Non-driver ID 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.
6 Home Address (DO NOT use PO Box) Apt. Municipality County Zip Code
7 Mailing Address if different from above Apt. Municipality County Zip Code
8 Last Address Registered to Vote (DO NOT use PO Box) Apt. Municipality County Zip Code
9 Former Name if Making Name Change Primary Phone Number (Optional) Email Address (Optional)
10 Do you wish to declare a political party affiliation?
11 Gender

Declaration - I swear or affirm that:

  • 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 conviction for an indictable offense under any federal or state law
  • I understand that any false or fraudulent reigstration 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

By entering your name and the date, you hereby agree to the terms of the Electronic Signatures in Global and National Commerce Act (Pub. L 106-229, 114 Stat. 464, enacted June 30, 2000, 15 U.S.C. ch. 96)

x Date:

If applicant is unable to complete this form, print the name and address of individual who completed this form.

Name
Date
Address

Important Instructions for sections 5, 6 and 10

  1. Registrants who are submitting this form by mail and are registering to vote for the first time: If you do not have any of the information required by section 5, or the information you provide cannot be verified, you will be asked to provide a COPY of a current and valid photo ID, or a document with your name and current address on it to avoid having to provide identification at the polling place. Note: ID Numbers are Confidential and will not be released by any governmental agency. Any person who uses such numbers illegally shall be subject to criminal penalties.
  2. If you are homeless, you may complete section 6 by providing a contact point or the location where you spend most of your time.
  3. 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 p