p.2 LIC112_0119
E. Voter Registration
To vote in Massachusetts you must be: A U.S. CITIZEN, a resident of Massachusetts and at least 18 years old on or before the next election in your city
or town, which could be a town meeting, city or town preliminary, city or town election, state primary, state election, special state primary, special state
election, or special city or town election.
1. Do you want to register to vote? .........................................................................................................................................................
Yes
No
• Check “Yes” if you want to register to vote, or you are changing your name or address and want to be registered to vote with this new information.
• If you answered “yes,” complete question #2 and read the Affirmation Section below.
• Check “No” if you are currently registered to vote and do not want to change your voter registration.
2. Are you a citizen of the United States of America? .............................................................................................................................
Yes
No
NOTE: If you answered “no” to this question, do not complete question #3. You are not eligible to register to vote at this time.
3. Please indicate party enrollment or political designation (check one).
Democratic
Republican
Libertarian
Green-Rainbow
No Party (unenrolled)
Political Designation (not a political party) (Print desired designation): ______________________________________
PLEASE ASK THE LICENSE CLERK FOR YOUR VOTER REGISTRATION RECEIPT
AFFIRMATION TO BE READ BY APPLICANTS REGISTERING TO VOTE
I hereby swear (affirm) that I am the person named above, that the above information is true, that I AM A CITIZEN OF THE UNITED STATES, that I
am at least 16 years old and I understand that I must be 18 years old to be eligible to vote, that I am not a person under a guardianship which prohibits
my registering to vote, that I am not temporarily or permanently disqualified by law from voting because of corrupt practices in respect to elections, that I
am not currently incarcerated for a felony conviction, and that I consider this residence to be my home. Signed under the penalty of perjury.
Confidentiality of voter registration information: If you register to vote, the office at which you submit your application will remain confidential and will
be used only for voter registration purposes. If you decline to register to vote, the fact that you declined to register will remain confidential and will be
used only for voter registration purposes.
Penalty for illegal voter registration: Fine of not more than $10,000 or imprisonment for not more than five years or both (M.G.L., Chap. 56, Section 8).
