Full Text
Rev. 03/10/2026 New York State Voter Registration Form Para obtener este formulario en español, llame al 1-[PHONE REDACTED] 한국어 양식을 원하시면 1-[PHONE REDACTED] 번으로 전화하세요 پر کال کریں1-[PHONE REDACTED] اس فارم کے اردو نسخے کے لیے如需此表格的中文版本，請撥打 1-[PHONE REDACTED] Para sa mabuo na ito sa Tagalog, tumawag sa 1-[PHONE REDACTED] ഈ മലയാാളത്തിിൽ ലഭിിക്കാാൻ, 1-[PHONE REDACTED] എന്ന നമ്പറിിൽ വിിളിക്കുക বাংđংলাায় এই ফর্মেćের জন্যয 1-[PHONE REDACTED] নম্বরে� কল করুন 1 Are you a citizen of the U.S.? Yes No For board use only If you answer No, you cannot register to vote. 2 If you answer No to both of the prior questions, you cannot register to vote. 3 Last Name Suffix Middle Initial First Name 4 M M D D Y Y Y Y Birthdate / / 5 Gender 6 Phone – – 7 Email 8 Address (not P.O. box) Apt. Number Zip code City/Town/Village New York State County 9 Address or P.O. box P.O. Box Zip code City/Town/Village 10 Have you voted before? Yes No 11 What year? 12 Your name was Your address was Your previous state or New York State County was 13 14 I wish to enroll in a political party Democratic party Republican party Conservative party Working Families party Other No party 16 Sign Date Optional questions 15 I need to apply for a mail ballot. I would like to be an Election Day worker. It is a crime to procure a false registration or to furnish false information to the Board of Elections. Please print in blue or black ink. B) Are you at least 16 years of age and understand that you must be 18 years of age on or before Election Day to vote, and that until you will be eighteen years of age at the time of such election your registration will be marked “pending” and you will be unable to cast a ballot in any election? Yes No Affidavit: I swear or affirm that • I am a citizen of the United States. • I will have lived in the county, city or village for at least 30 days before the election. • I meet all requirements to register to vote in New York State. • This is my signature or mark in the box below. • The above information is true, I understand that if it is not true, I can be convicted and fined up to $5,000 and/or jailed for up to four years. A) Will you be 18 years of age or older on or before Election Day? Yes No Your name More information Items 5, 6 & 7 are optional The address where you receive mail Skip if same as above The address where you live Voting history Voting information that has changed Skip if this has not changed or you have not voted before Identification You must make one selection. If you have a NY DMV number, you must provide it. For questions, please refer to Verifying your identity above. I have a New York DMV number: I do not have a New York DMV number or a Social Security number. I do not have a New York DMV number. The last four digits of my Social Security number are: x x x - x x - I do not want to enroll in any political party and wish to be an independent voter Political party You must make 1 selection Political party enrollment is optional but that, in order to vote in a primary election of a political party, a voter must enroll in that political party, unless state party rules allow otherwise. Qualifications Register to vote With this form, you register to vote in elections in New York State. You can also use this form to: • change the name or address on your voter registration • become a member of a political party • change your party membership • pre-register to vote if you are 16 or 17 years of age To register you must: • be a US citizen; • be 18 years old (you may pre-register at 16 or 17 but cannot vote until you are 18); • not be in prison for a felony conviction; • not claim the right to vote elsewhere; • not found to be incompetent by a court. Verifying your identity We will try to check your identity before Election Day, using your DMV number (driver’s license number or non-driver ID number), or the last four digits of your Social Security number, which you will fill in below. If you have a DMV number, you must provide it. If you do not have a DMV number, you must provide the last four digits of your Social Security number. If you have neither, you may provide a valid photo ID, current utility bill, bank statement, paycheck, government check or some other government document that shows your name and address. You may include a copy of one of those types of ID with this form—be sure to tape the sides of the form closed. If we are unable to verify your identity before Election Day, you will be asked for ID when you vote for the first time. Send or deliver this form Fill out the form below and send it to your county’s address on the back of this form, or take this form to the office of your County Board of Elections. This form must be received no later than 10 days before the election you want to vote in. Your county will notify you that you are registered to vote. Questions? Call your County Board of Elections listed on the back of this form or 1-800-FOR-VOTE (TDD/TTY Dial 711). Find answers or tools on our website www.elections.ny.gov ---PAGE BREAK--- Address and stamp this section Your address Your County Board of Elections address (select from below) Place First-Class Stamp Here Before mailing, remove tape, fold and seal Eye color If you would like to be an organ and tissue donor upon your death, you may enroll in the NYS Donate Life™ Registry online at www.donatelife.ny.gov or complete the form below. You will receive a confirmation email or letter, which will also provide you an opportunity to limit your donation. By signing below, you certify that you are: • 16 years of age or older; • consenting to donate all of your organs and tissues for transplantation, research, or both; • authorizing the Board of Elections to provide your name and identifying information to NYS Donate Life™ Registry for enrollment; • and authorizing the Registry to give access to this information to federally regulated organ procurement organizations and NYS-licensed tissue and eye banks and others approved by the NYS Commissioner of Health upon your death. (Optional) Register to donate your organs and tissues Last name First name Address Apt. Number Gender M F City Height Ft. In. Sign Date Suffix Middle Initial Zip code Birth date Y Y Y Y D D / / M M New York City 32 Broadway, 7th Fl. New York, NY 10004 (212) 487-5300 Albany 260 S. Pearl St. Albany, NY 12202 (518) 487-5060 Allegany 8 Willets Ave. Belmont, NY 14813 (585) 268-9294 Broome Government Plaza 60 Hawley St. PO Box 1766 Binghamton, NY 13902 (607) 778-2172 Cattaraugus 207 Rock City St. Suite 100 Little Valley, NY 14755 (716) 938-2400 Cayuga 157 Genesee St. (Basement) Auburn, NY 13021 (315) 253-1285 Chautauqua 7 North Erie St. Mayville, NY 14757 (716) 753-4580 Chemung 378 South Main St. PO Box 588 Elmira, NY 14902 (607) 737-5475 Chenango 5 Court St. Norwich, NY 13815 (607) 337-1760 Clinton Cnty Government Ctr. Ste. 104 137 Margaret St. Plattsburgh, NY 12901 (518) 565-4740 Columbia 401 State St. Hudson, NY 12534 (518) 828-3115 Cortland 112 River St. Suite 1 Cortland, NY 13045 (607) 753-5032 Delaware 97 Main St. Suite 5 Delhi, NY 13753 (607) 832-5321 Dutchess 112 Delafield Street Suite 200 Poughkeepsie, NY 12601 (845) 486-2473 Erie 134 W. Eagle St. Buffalo, NY 14202 (716) 858-8891 Essex 7551 Court St. PO Box 217 Elizabethtown, NY 12932 (518) 873-3474 Franklin 355 West Main St. Ste. 161 Malone, NY 12953 (518) 481-1663 Fulton 2714 St. Hwy 29 Ste. 1 Johnstown, NY 12095 (518) 736-5526 Genesee County Building #1 15 Main St. Batavia, NY 14020 (585) 815-7804 Greene 411 Main St. Ste. 437 Catskill, NY 12414 (518) 719-3550 Hamilton Rte. 8 PO Box 175 Lake Pleasant, NY 12108 (518) 548-4684 Herkimer 109 Mary St. Ste. 1306 Herkimer, NY 13350 (315) 867-1102 Jefferson 175 Arsenal St. Watertown, NY 13601 (315) 785-3027 Lewis 7660 N. State St. Lowville, NY 13367 (315) 376-5329 Livingston County Govt. Ctr. 6 Court St. Room 104 Geneseo, NY 14454 (585) 243-7090 Madison County Office Bldg. N. Court St. PO Box 666 Wampsville, NY 13163 (315) 366-2231 Monroe 435 Smith St. Rochester, NY 14608 (585) 753-1550 Montgomery Old Courthouse 9 Park St. PO Box 1500 Fonda, NY 12068 (518) 853-8180 Nassau 240 Old Country Rd. 5th Fl. PO Box 9002 Mineola, NY 11501 (516) 571-8683 Niagara 111 Main St. Ste. 100 Lockport, NY 14094 (716) 438-4040 Oneida Union Station 321 Main St. 3rd Fl. Utica, NY 13501 (315) 798-5765 Onondaga 1000 Erie Blvd West Syracuse, NY 13204 (315) 435-3312 Ontario 74 Ontario St. Canandaigua, NY 14424 (585) 396-4005 Orange 75 Webster Ave PO Box 30 Goshen, NY 10924 (845) 360-6500 Orleans 14016 Route 31 West, Ste. 140 Albion, NY 14411 (585) 589-3274 Oswego 74 Bunner St. Oswego, NY 13126 (315) 349-8350 Otsego Ste. 2 140 County Hwy. 33W Cooperstown, NY 13326 (607) 547-4247 Putnam 25 Old Route 6 Carmel, NY 10512 (845) 808-1300 Rensselaer Ned Pattison Government Ctr. 1600 Seventh Ave. Troy, NY 12180 (518) 270-2990 Rockland 11 New Hempstead Rd. New City, NY 10956 (845) 638-5172 St. Lawrence 80 State Hwy 310 Canton, NY 13617 (315) 379-2202 Saratoga 50 W. High St. Ballston Spa, NY 12020 (518) 885-2249 Schenectady 2696 Hamburg St. Schenectady, NY 12303 (518) 377-2469 Schoharie County Office Bldg. 284 Main St. PO Box 99 Schoharie, NY 12157 (518) 295-8388 Schuyler County Office Bldg. 105 9th St., Unit 13 Watkins Glen, NY 14891 (607) 535-8195 Seneca One DiPronio Dr. Waterloo, NY 13165 (315) 539-1760 Steuben 3 E. Pulteney Sq. Bath, NY 14810 (607) 664-2260 Suffolk Yaphank Ave. PO Box 700 Yaphank, NY 11980 (631) 852-4500 Sullivan Gov’t. Ctr. 100 North St. PO Box 5012 Monticello, NY 12701 (845) 807-0400 Tioga 1062 State Rte. 38 PO Box 306 Owego, NY 13827 (607) 687-8261 Tompkins Court House Annex 128 E. Buffalo St. Ithaca, NY 14850 (607) 274-5522 Ulster 79 Hurley Ave. Suite 112 Kingston, NY 12401 (845) 334-5470 Warren Cnty. Municipal Ctr. 3rd Floor Human Serv. Bldg 1340 St. Rte. 9 Lake George, NY 12845 (518) 761-6456 Washington 1153 Burgoyne Ave. Fort Edward, NY 12828 (518) 746-2180 Wayne 7376 State Rte. 31 PO Box 636 Lyons, NY 14489 (315) 946-7400 Westchester 445 Hamilton Ave. 8th Floor White Plains, NY 10601 (914) 995-5700 Wyoming 4 Perry Ave. Warsaw, NY 14569 (585) 786-8931 Yates Ste. 1124 417 Liberty St. Penn Yan, NY 14527 (315) 536-5135 Email DMV or ID NYC #