New Hampshire Voter Registration Form

New Hampshire Voter Registration Form.pdf To vote in the State of New Hampshire download the form and submit it to the state office.




Shaded Areas Not Required

You can use this form to: This space is for official use only.
•register to vote
•report that your name or address has changed
•register with a party
Please print in blue or black ink
Mr. Last Name First Name Middle Name(s) (Circle one)
1 Mrs.
Miss. Jr Sr II III IV
Address (see instructions) — Street (or route and box number). 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

Date of Birth Telephone Number (optional) ID Number (see item 6 in the instructions for your State)
4 5 6
Month Day Year
7 Choice of Party (see Item 7 in the instructions for your State) 8 Race or Ethnic Group (see item 8 in the instructions for your State)

I swear/affirm that: Please sign full name (or put mark)
•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.) X
9 •The information I have provided is true to the best of my
knowledge under penalty of perjury. If I have provided Date:
false information, I may be subject to a fine or imprison-
ment or both under Federal or State laws. Month Day Year

If the applicant is unable to sign, who helped the applicant fill out this application? Give name, address and phone number (phone number optional).

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Please fill out the sections below if they apply to you. Fold here
If this application is for a change of name, what was your name before you changed it?
Mr. Last Name First Name Middle Name(s) (Circle one)
A Mrs.
Miss Jr Sr II III IV

If you were registered before but this is the first time you are registering from the address in Box 2, what was your address where you were registered before?

B Street (or route and box number) Apt, or Lot # City/Town State Zip Code

If you live in a rural area but do not have a street number, or if you have no address, please show on the map where you live.

•Write in the names of the crossroads (or streets) nearest to where you live. NORTH
•Draw an X to show where you live.
•Use a dot to show any schools, churches, stores, or other landmarks
near where you live, and write the name of the landmark.
Example 2
e *Grocery Store
u Woodchuck Road
Public School* R X

DD Form 2644, NOV 94

New Hampshire town and city clerks will accept this application It should be mailed in plenty of time for your town or city clerk to
only as a request for their own absentee voter mail-in registration mail to you their own form and for you to return that form to them
form. You need to fill in only Box 1 and Box 2 or 3. The by 10 days before the election.
application should be mailed to your town or city clerk at your zip
code or to: Assistance and questions may be addressed to the next higher
command or to the Federal Voting Assistance Program at
State House 800-438-8683 or e-mail at

Room 204
Concord, NH 03301