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    Essex Voter Reg Form 080309

    Uploaded by

    Terry Hurlbut
    The document provides instructions for completing a New Jersey voter registration application. It states that the form must be printed, signed, and mailed to the appropriate county office in order to register to vote. It also lists the eligibility requirements to register, including being a U.S. citizen, at least 18 years old by the next election, and a state and county resident for at least 30 days.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    Essex Voter Reg Form 080309

    Uploaded by

    Terry Hurlbut
    28 views2 pages
    The document provides instructions for completing a New Jersey voter registration application. It states that the form must be printed, signed, and mailed to the appropriate county office in order to register to vote. It also lists the eligibility requirements to register, including being a U.S. citizen, at least 18 years old by the next election, and a state and county resident for at least 30 days.

    Original Description:

    Voter registration form for registering to vote with the Essex County Superintendent of Elections

    Copyright

    © Attribution Non-Commercial (BY-NC)

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    The document provides instructions for completing a New Jersey voter registration application. It states that the form must be printed, signed, and mailed to the appropriate county office in order to register to vote. It also lists the eligibility requirements to register, including being a U.S. citizen, at least 18 years old by the next election, and a state and county resident for at least 30 days.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    28 views2 pages

    Essex Voter Reg Form 080309

    Uploaded by

    Terry Hurlbut
    The document provides instructions for completing a New Jersey voter registration application. It states that the form must be printed, signed, and mailed to the appropriate county office in order to register to vote. It also lists the eligibility requirements to register, including being a U.S. citizen, at least 18 years old by the next election, and a state and county resident for at least 30 days.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 2

    Please fill out and print the completed form.

    YOU MUST SIGN YOUR NAME and then mail to the appropriate county in order to be registered.

    New Jersey 76
    Voter Registration Application
    Please print clearly in ink. All information is required unless marked optional.

    1 Check boxes New Registration Address Change Political Party Affiliation FOR OFFICIAL
    that apply: Name Change Signature Update or Non-affiliation Change USE ONLY
    Clerk
    2 Are you a U.S. Citizen? Yes No Will you be 18 years of age by the next election? Yes No
    (If No, DO NOT complete this form) (If No, DO NOT complete this form)
    Registration #
    3 Last Name First Name Middle Name or Initial Suffix (ex. Jr., Sr., III)

    Office Time Stamp


    4 Date of Birth (MM/DD/YY)
    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.
    “I swear or affirm that I DO NOT have a NJ Driver’s License, MVC Non-driver ID or a Social Security Number.”

    6 Home Address (DO NOT use PO Box) Apt. Municipality County State Zip Code

    7 Mailing Address if different from above Apt. Municipality County State Zip Code

    8 Last Address Registered to Vote (DO NOT use PO Box) Apt. Municipality County State Zip Code by mail
    in person

    9 Former Name if Making Name Change Day Phone Number


    (Optional)

    10 Do you wish to declare a political party affiliation?(Optional) Yes, the party name is
    No, I do not wish to be affiliated with any political party.
    11 Gender Declaration - I swear or affirm that: I will have resided in the State and county I understand that any false or
    I am a U.S. Citizen at least 30 days before the next election fraudulent registration may subject
    Female I live at the above address I am not on parole, probation or serving a me to a fine of up to $15,000,
    Male I will be at least 18 years old sentence due to a conviction for an indictable imprisonment up to 5 years,
    on or before the next election offense under any federal or state laws or both pursuant to R.S. 19:34-1

    Signature: Sign or mark and date on line below If applicant is unable to complete this form, print the
    name and address of individual who completed this form.
    Name Date
    X Address
    Date

    Important Instructions for sections 5, 6 and 10


    5) 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.
    6) If you are homeless, you may complete section 6 by providing a contact point or the location where you spend most of your time.
    10) You may declare a political affiliation or you may declare to be unaffiliated, regardless of any prior party affiliation. Completing
    section 10 is Optional and will not affect the acceptance of your voter registration application.
    Need More Information? Check boxes below if you would like to receive more information about:
    voting by mail polling place accessibility available election materials in this
    alternative language:
    becoming a poll worker voting if you have a disability,
    including visual impairment
    For further information visit www.NJElections.org or call toll-free 1-877-NJVOTER (1-877-658-6837)
    NJDOE-lv-8/3/09
    New Jersey
    Voter Registration Information
    You can register to vote if:
    n You are a United States citizen
    n You will be 18 years of age by the next election
    n You will be a resident of the State and county 30 days before the election
    n You are NOT currently serving a sentence, probation or parole because of a felony conviction
    Registration Deadline: 21 days before an election
    Your County Commissioner of Registration will notify you if your application is accepted.
    If it is not accepted, you will be notified on how to complete and/or correct the application.
    Questions? visit www.NJElections.org or call toll-free 1-877-NJVOTER (1-877-658-6837)

    1 FOLD

    2 FOLD

    Important: Print out at 100% - DO NOT REDUCE. Fold as illustrated to ensure proper mailing.

    New Jersey
    Voter Registration Application
    You can register to vote if:
    n You are a United States citizen
    n You will be 18 years of age by the next election
    n You will be a resident of the county 30 days before the election
    n You are NOT currently serving a sentence, probation or parole because of a felony conviction
    Registration Deadline: 21 days before an election
    Your County Commissioner of Registration will notify you if your application is accepted.
    If it is not accepted, you will be notified on how to complete and/or correct the application.
    Questions? visit www.NJElections.org or call toll-free 1-877-NJVOTER (1-877-658-6837)

    FOLD TRENTON NJ 08625-9983


    PO BOX 304
    NJ DIVISION OF ELECTIONS

    FOLD

    Put both pages 1 fold top down 2 fold bottom up 3 Tape top shut
    together as shown

    TAPE HERE 3

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