New Jersey Voter Registration Form
New Jersey Voter Registration Form
Check the boxes that apply.
New Registration
Name Change
Address Change
Signature Update
Political Party Affiliation or Non-Affiliation Change
Are you a U.S Citizen? (If no, DO NOT complete this form.)
Yes
No
Are you at least 17 years of age? (If no, DO NOT complete this form.)
Yes
No
Last Name:
First Name:
Middle Name or Inital:
Suffix (Jr. Sr. III, etc.):
Date of Birth:
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.
“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:
Apt:
Municipality:
County:
Zip Code:
Mailing Address(if different from above):
Apt:
Municipality:
County:
Zip Code:
Last Registered Address:
Apt:
Municipality:
County:
Zip Code:
Former Name(if name change has been made)
Contact Information(optional)
Phone Number:
E-mail Address:
Gender
Male
Female
Other
Help
Phone number: 908-555-0100
Email: Email@nj.com
Online help
