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New York State Voter Registration Form 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 Para obtener este formulario en español, llame al 1-[PHONE REDACTED] 한국어 양식을 원하시면 1-[PHONE REDACTED] 번으로 전화하세요 Para sa mabuo na ito sa Tagalog, tumawag sa 1-[PHONE REDACTED] বাংđংলা đয় এই ফর্মেćর জন্যয1-[PHONE REDACTED] ন্যম্বর্মের ক লা কর ন্য 如需此表格的中文版本，請撥打 1-[PHONE REDACTED] پر کال کریں1-[PHONE REDACTED] اس فارم کے اردو نسخے کے لیے ഈ മലയാംളത്തിിൽ ലഭിിക്കാംൻ, 1-[PHONE REDACTED] എന്ന നമ്പറിിൽ വിിളിക്കാുക ু ে 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. 1 Yes No Are you a citizen of the U.S.? If you answer No, you cannot register to vote. For board use only Yes No A) Will you be 18 years of age or older on or before Election Day? 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 Qualifications 2 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 If you answer No to both of the prior questions, you cannot register to vote. Last Name Suffix 3 Your name First Name Middle Initial – – M M D D Y Y Y Y 5 Gender / / 4 Birthdate More information Items 5, 6 & 7 are optional 7 Email 6 Phone Address (not P.O. box) The address where you live 8 Apt. Number City/Town/Village New York State County Zip code The address where you receive mail Skip if same as above 9 Address or P.O. box P.O. Box City/Town/Village Zip code Yes Voting history 10 Have you voted before? No 11 What year? Voting information Your name was that has changed 12 Your address was Skip if this has not changed or you have not voted before Your previous state or New York State County was Identification I have a New York DMV number: You must make one selection. If I do not have a New York DMV number. you have a NY DMV number, you 13 must provide it. For questions, The last four digits of my Social Security number are: x x x - x x - please refer to Verifying your identity above. I do not have a New York DMV number or a Social Security number. 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. 14 I wish to enroll in a political party Democratic party Republican party Conservative party Working Families party Other I do not want to enroll in any political party and wish to be an independent voter No party 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. 16 Sign I need to apply for a mail ballot. Optional questions 15 I would like to be an Election Day worker. 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