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

To register you must:

• be a US citizen;
• be 18 years old by the end of this year;
• not be in prison or on parole for a felony conviction (unless parole pardoned or restored rights of citizenship);
• not claim the right to vote elsewhere;
• not found to be incompetent by a court.

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.

Mail or deliver this form at least 25 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

Verifying your identity

We'll try to check your identity before Election Day, through the DMV number (driver's license number or non-driver ID number), or the last four digits of your social security number, which you'll fill in below.

If you do not have a DMV or social security number, you may use a valid photo ID, a 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.

Información en español: si le interesa obtener este formulario en español, llame al 1-800-367-8683

中文資料:若您有興趣索取中文資料表格, 請電: 1-800-367-8683

한국어: 한국어 양식을 원하시면 1-800-367-8683 으로 전화 하십시오.

The original also carries this notice in Bengali, with the same phone number, 1-800-367-8683.

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.

The form

Qualifications

1. Are you a citizen of the U.S.? Yes / No
   If you answer No, you cannot register to vote.
2. Will you be 18 years of age or older on or before election day? Yes / No
   If you answer No, you cannot register to vote unless you will be 18 by the end of the year.

For board use only

Your name

3. Last name, Suffix, First name, Middle Initial

More information (Items 5, 6 & 7 are optional)

4. Birth date (MM DD YYYY)
5. Gender
6. Phone
7. Email

The address where you live

8. Address (not P.O. box), Apt. Number, Zip code, City/Town/Village, New York State County

The address where you receive mail (Skip if same as above)

9. Address or P.O. box, P.O. Box, Zip code, City/Town/Village

Voting history

10. Have you voted before? Yes / No
11. What year?

Voting information that has changed (Skip if this has not changed or you have not voted before)

12. Your name was; Your address was; Your previous state or New York State County was

Identification (You must make 1 selection)

For questions, please refer to Verifying your identity above.

13. New York State DMV number / Last four digits of your Social Security number (xxx - xx - ____) / I do not have a New York State driver's license 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; Green party; Libertarian party; Independence party; SAM party; Other
    I do not want to enroll in any political party and wish to be an independent voter: No party

Optional questions

15. I need to apply for an Absentee ballot. / I would like to be an Election Day worker.

Affidavit: I swear or affirm that

16. • 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.
    Sign; Date

Rev. 01/2019

Address and stamp this section

Your address. Place First-Class Stamp Here. Your County Board of Elections address (select from below). Before mailing, remove tape, fold and seal.

(Optional) Register to donate your organs and tissues

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.

• Last name, First name, Middle Initial, Suffix
• Address, Apt. Number, Zip code, City
• Birth date (MM DD YYYY)
• Gender: M / F
• Eye color
• Height: Ft. In.
• Email
• DMV or ID NYC #
• Sign; Date

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.