New Hampshire Voter Registration Application
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NEW HAMPSHIRE
MAIL-IN VOTER REGISTRATION APPLICATION
Shaded Areas Not Required
You can use this form to:
• register to vote
• report that your name or address has changed
• register with a party
Please print in blue or black ink
Mr.
First Name
1 Mrs. Last Name
Miss.
Ms.

This space is for official use only.

Middle Name(s)

(Circle one)
Jr Sr II III IV

Apt., or Lot #

City/Town

State

Zip Code

Address Where You Get Your Mail If Different From Above (see instructions)

City/Town

State

Zip Code

Address (see instructions) — Street. (or route and box number)

2
3
4

Date of Birth
Month Day Year

5

Telephone Number (optional)

6

7 Choice of Party (see Item 7 in the instructions for your State)

9

10

I swear/affirm that:
• I am a United States citizen
I meet the eligibility requirements of my state and
subscribe to any oath required.
(See item 9 in the instructions for your state before you sign.)
•The information I have provided is true to the best of my
knowledge under penalty of