New York State Voter Registration Form printable pdf download

New York State Voter Registration Form

Send or deliver this form

Verifying your identity

Fill out the form below and send it to your

We’ll try to check your identity before Election

With this form, you register to vote in elections in

county’s address on the back of this form,

Day, through the DMV number (driver’s license

New York State. You can also use this form to:

or take this form to the office of your County

number or non-driver ID number), or the last

Board of Elections.

four digits of your social security number,

• change the name or address

which you’ll fill in below.

on your voter registration

Mail or deliver this form at least 25 days before

• become a member of a political party

the election you want to vote in. Your county will

If you do not have a DMV or social security

notify you that you are registered to vote.

number, you may use a valid photo ID, a current

• change your party membership

utility bill, bank statement, paycheck, government

Questions?

check or some other government document that

To register you must:

shows your name and address. You may include a

Call your County Board of Elections

copy of one of those types of ID with this form—

• be a US citizen;

listed on the back of this form or

be sure to tape the sides of the form closed.

• be 18 years old by the end of this year;

1-800-FOR-VOTE (TDD/TTY Dial 711)

• not be in prison or on parole

If we are unable to verify your identity before

for a felony conviction;

Find answers or tools on our website

Election Day, you will be asked for ID when

• not claim the right to vote elsewhere.

you vote for the first time.

Información en español: si le interesa obtener este

যদি আপদি এই ফর্ম টি বাংলাতে পপতে চাি োহতল

中文資料:若您有興趣索取中文資料表格,

한국어: 한국어 양식을 원하시면

請電: 1-800-367-8683

1-800-367-8683

formulario en español, llame al 1-800-367-8683

িম্বতে পফাি করুি

으로 전화 하십시오.

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.

Are you a citizen of the U.S.?

Yes

For board use only

If you answer No, you cannot register to vote.

Qualifications

Will you be 18 years of age or

Yes

older on or before election day?

If you answer No, you cannot register to vote unless you will be 18 by the end of the year.

Last name

Suffix

Your name

First name

Middle Initial

Birth date

Sex

M M

More information

Items 5, 6 & 7 are optional

Phone

–

Address (not P.O. box)

Apt. Number

Zip code

The address

where you live

City/Town/Village

New York State County

Address or P.O. box

The address where

you receive mail

P.O. Box

Zip code

Skip if same as above

City/Town/Village

Voting history

Have you voted before?

Yes

What year?

Your name was

Voting information

that has changed

Your address was

Skip if this has not changed

Your previous state or New York State County was

or you have not voted before

Identification

New York State DMV number

You must make 1 selection

x x x – x x –

Last four digits of your Social Security number

For questions, please refer to

I do not have a New York State driver’s license or a Social Security number.

Verifying your identity above.

I wish to enroll in a political party

Affidavit: I swear or affirm that

Political party

Democratic party

• I am a citizen of the United States.

You must make 1 selection

Republican party

• I will have lived in the county, city or village

Conservative party

for at least 30 days before the election.

Political party enrollment is

Green party

• I meet all requirements to register

optional but that, in order to

to vote in New York State.

Working Families party

vote in a primary election of

• This is my signature or mark in the box below.

Independence party

a political party, a voter must

• The above information is true, I understand that

Women’s Equality party

enroll in that political party,

unless state party rules allow

if it is not true, I can be convicted and fined up

Reform party

otherwise.

to $5,000 and/or jailed for up to four years.

Other

I do not wish to enroll in a political party

Sign

No party

I need to apply for an Absentee ballot.

Optional questions

Date

I would like to be an Election Day worker.

New York State Voter Registration Form

Related Articles

Related forms

Related Categories