New Jersey
Vote Registration Application
Please print clearly in ink. All information is required unless marked optional
Register to Vote
Choose Boxes that Aply
New Registration
Name Change
Address Change
Signature Update
Political Party Affiliation or Non-Afiliation Change
Eligibility (If No. DO NOT complete this )
Are you a U.S Citizen?
Yes
No
Are you atleast 17 years of age?
Yes
No
Basic Personal Information
*
FirstName:
*
LastName:
*
Middle Name or Initial:
*
Suffix (Jr., Sr., III)
Date of Birth
*
Personal Identification Information
*
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.”
Legal Residential Adress
*
Adress Line 1:
Apt.
*
Municipality:
Newark
Jersey City
Paterson
Elizabeth
Clifton
*
County:
*
State:
*
Zip Code:
Warren
Morris
Bergen
Atlantic City
Camden
Mailing Adress(If different from above)
Adress Line 1:
Apt.
Municipality:
Newark
Jersey City
Paterson
Elizabeth
Clifton
County:
State:
Zip Code:
Warren
Morris
Bergen
Atlantic City
Camden
Last Adress Registered to Vote
Adress Line 1:
Apt.
Municipality:
Newark
Jersey City
Paterson
Elizabeth
Clifton
County:
State:
Zip Code:
Warren
Morris
Bergen
Atlantic City
Camden
Personal Information
Former Name (if Making Name Change)
Day Phone Number
E-mail Address
Gender:
Male
Female
Other
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 country at least 30 days before the next election
I am not on parole, probation or serving a sentence due to a conviction of 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, imprsionment up to 5 years, or both pursuant to R.S. 19:34-1
Signature: Type your full name below
X
Date
Social Security Number
By typing your name above you agree that it counts as a valid signature and therefore is legally binding.