Fillable Form 76: Voter Registration Application (Township of North Brunswick)

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Form 76: Voter Registration Application (Township of North Brunswick)

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The Form 76: Voter Registration Application (Township of North Brunswick) form is 1 page long and contains:

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  • 11 check-boxes
  • 55 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Township of North Brunswick

BROWSE TOWNSHIP OF NORTH BRUNSWICK (NJ) FORMS

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NJ Division of Elections - 02/16/16
New Jersey
Voter Registration Application
Need More Information? Check boxes below if you would like to receive more information about:
o
voting by mail
o
polling place accessibility
o
available election materials in
o
becoming a poll worker
 o
voting if you have a disability,
this alternative language:

including visual impairment
For further information visit Elections.NJ.gov or call toll-free 1-877-NJVOTER (1-877-658-6837)
Important Instructions for sections 5, 6 and 10
5) Registrantswhoaresubmittingthisformbymailandareregisteringtovoteforthersttime:Ifyoudonothaveanyoftheinformation
requiredbysection5,ortheinformationyouprovidecannotbeveried,youwillbeaskedtoprovideaCOPYofacurrentandvalid
photoID,oradocumentwithyournameandcurrentaddressonittoavoidhavingtoprovideidenticationatthepollingplace.
Note: ID Numbers are Condential and will not be released by any governmental agency. Any person who uses such numbers
illegally shall be subject to criminal penalties.
6) Ifyouarehomeless,youmaycompletesection6byprovidingacontactpointorthelocationwhereyouspendmostofyourtime.
10) Youmaydeclareapoliticalpartyafliationoryoumaydeclaretobeunafliated,regardlessofanypriorpartyafliation.Ifyouarea
previouslyafliatedvoterwhowantstochangepoliticalpartyafliationorbecomeunafliated,youmustlethisformnolaterthan
55daysbeforetheprimaryelectioninordertovoteintheprimaryelection.Completingsection10isOPTIONALandwillnotaffect
theacceptanceofyourvoterregistrationapplication.
Checkboxes
o
New Registration
o
AddressChange
o
PoliticalPartyAfliation 
that apply:
o
NameChange
o
SignatureUpdateorNon-afliationChange
Do you wish to declare a political party afliation?
o
Yes, the party name is
.
(Optional)
o
No, I do not wish to be afliated with any political party.
If you DO NOT have a NJ Driver’s License or MVC Non-Driver
ID, provide the last 4 digits of your Social Security Number.
Are you a U.S. Citizen? o Yes o No
(If No, DO NOT complete this form)
Date of Birth
NJ Driver’s License Number or MVC Non-driver ID Number
Last Name
First Name
Middle Name or Initial
Sufx
(Jr., Sr., III)
Home Address (DO NOT use PO Box)
Apt.
Municipality
County Zip Code
Are you at least 17 years of age? o Yes o No
(If No, DO NOT complete this form)
Mailing Address if different from above
Last Address Registered to Vote (DO NOT use PO Box)
Former Name if Making Name Change
b. E-Mail Address (Optional)
Gender
o
Female
o
Male
Apt.
Municipality
County
Zip Code
Apt.
Municipality
County
Zip Code
8
10
2
3
4
5
6
7
Signature: Sign or mark and date on lines below
11
9
If applicant is unable to complete this form, print the
name and address of individual who completed this form.
Name
Date
Address
Clerk
Registration #
Ofce Time Stamp
o by mail
o in person
o
“I swear or afrm that I DO NOT have a NJ Driver’s License, MVC Non-driver ID or a Social Security Number.”
Declaration - I swear or afrm that:
l
I am a U.S. Citizen
l I live at the above address
l I am at least 17 years old, and under-
stand that I may not vote until reaching
the age of 18.
FOR OFFICIAL
USE ONLY
1
Date
State
State
State
Please print clearly in ink. All information is required unless marked optional.
a. Day Phone Number (Optional)
X
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __
__ __ __ __
l I will have resided in the State and county
at least 30 days before the next election
l I am not on parole, probation or serving a
sentence due to a conviction for an indictable
offense under any federal or state laws
l I understand that any false or
fraudulent registration may subject
me to a ne of up to $15,000,
imprisonment up to 5 years, or
both pursuant to R.S. 19:34-1
76
New Jersey
Voter Registration Information
FOLD
2
You can register to vote if:
n You are a United States citizen.
n You are at least 17 years of age.*
n You will be a resident of the State and county 30 days before the election.
n You are NOT currently serving a sentence, probation or parole because of a felony conviction.
*You may register to vote if you are at least 17 years old but cannot vote until reaching the age of 18.
Registration Deadline: 21 days before an election
Your County Commissioner of Registration will notify you if your application is accepted.
If it is not accepted, you will be notied on how to complete and/or correct the application.
Questions? visit Elections.NJ.gov or call toll-free 1-877-NJVOTER (1-877-658-6837)
TAPE HERE
3
Important: Print out at 100% - DO NOT REDUCE. Fold as illustrated to ensure proper mailing.
Put both pages
together as shown
FOLD
FOLD
New Jersey
Voter Registration
1
fold top down
NJ DIVISION OF ELECTIONS
PO BOX 304
TRENTON NJ 08625-9983
FOLD
fold bottom up
2
Tape top shut
3
You can register to vote if:
n You are a United States citizen
n You will be 18 years of age by the next election
n You will be a resident of the county 30 days before the election
n You are NOT currently serving a sentence, probation or parole because of a felony conviction
Registration Deadline: 21 days before an election
Your County Commissioner of Registration will notify you if your application is accepted.
If it is not accepted, you will be notified on how to complete and/or correct the application.
FOLD
1
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Form 76: Voter Registration Application (Township of North Brunswick)

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Completed 14 July 2020

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