___ NEW REGISTRATION I am not registered to vote in New Hampshire |
___ TRANSFER I am registered to vote in New Hampshire and have moved my voting domicile to a new town or ward in New Hampshire |
___ NAME CHANGE/ADDRESS UPDATE I am registered to vote in this town/ward and have changed my name/address |
| Date ____________________ | |
VOTER REGISTRATION FORM |
(Please print or type) | |
1. Name_ | |
Last (suffix) First Full Middle Name | |
2. Domicile Address_ | |
Street Ward Number | |
_ | |
Town or City Zip Code | |
3. Mailing Address if different than in 2_ | |
Street | |
_ | |
Town or City Zip Code | |
4. Place and Date of Birth_ | |
| Town or City State | |
Date ____________________ | |
5. Are you a citizen of the United States? Yes _____ No _____ | |
If a naturalized citizen, give name of court where and date when naturalized | |
_ | |
6. Place last registered to vote_ | |
| Street Ward Number | |
I am not currently registered to vote elsewhere (initial here __________ ), or I request that my name be removed as a registered voter in ______________________________ (fill in your address where previously registered, street, city/town, state, and zip code) |
7. Name under which previously registered, if different from above | |
_ | |
8. Party Affiliation (if any)_ | |
9. Driver's License Number _________________________ State_ | |
If you do not have a valid driver's license, provide the last four digits of your social security number __________
___ NEW REGISTRATION I am not registered to vote in New Hampshire |
___ TRANSFER I am registered to vote in New Hampshire and have moved my voting domicile to a new town or ward in New Hampshire |
___ NAME CHANGE/ADDRESS UPDATE I am registered to vote in this town/ward and have changed my name/address |
Date registration form is submitted _______________ |
Date applicant moved to the address listed below as the voter's domicile __________ |
VOTER REGISTRATION FORM |
FOR USE STARTING 30 DAYS BEFORE AN ELECTION AND AT THE POLLING PLACE ON ELECTION DAY |
(Please print or type) |
1. Name_ | |
Last (suffix) First Full Middle Name | |
2. Domicile Address_ | |
| Street Ward Number | |
_ | |
Town or City Zip Code | |
3. Mailing Address if different than in 2_ | |
| | | | Street | |
_ | |
Town or City Zip Code | |
4. Place and Date of Birth_ | |
| Town or City State | |
Date ____________________ | |
5. Are you a citizen of the United States? Yes _____ No _____ | |
If a naturalized citizen, give name of court where and date when naturalized_ | |
6. Place last registered to vote_ | |
| Street Ward Number | |
I am not currently registered to vote elsewhere (initial here __________ ), or I request that my name be removed as a registered voter in ______________________________ (fill in your address where previously registered, street, city/town, state, and zip code) |
7. Name under which previously registered, if different from above | |
_ | |
8. Party Affiliation (if any)_ | |
9. Driver's License Number _________________________ State_ | |
If you do not have a valid driver's license, provide the last four digits of your social security number __________