Voter Registration Application - State of New JerseyVoter Registration Application - State of New Jersey
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New Jersey

Voter Registration Application
Please print clearly in ink. All information is required unless marked optional.

1 Check boxes o New Registration
that apply:

o Name Change

2 Are you a U.S. Citizen?

o Political Party Affiliation
or Non-affiliation Change

For Official
Use Only

Will you be 18 years of age by the next election? o Yes o No
(If No, DO NOT complete this form)

o Yes o No
(If No, DO NOT complete this form)

3 Last Name

o Address Change
o Signature Update

First Name

Middle Name or Initial Suffix (Jr., Sr., III)

4 Date of Birth

Clerk
Registration #
Office Time Stamp

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. __

__ __ __

o “I swear or affirm that I DO NOT have a NJ Driver’s License, MVC Non-driver ID or a Social Security Number.”

Apt.

Municipality

County

State