Fillable National Voter Registration Application Form For U.S. Citizens (KHM) (Election Assistance Commission)

Fill Online, Printable, Fillable, Blank National Voter Registration Application Form For U.S. Citizens (KHM) (Election Assistance Commission) Form

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National Voter Registration Application Form For U.S. Citizens (KHM) (Election Assistance Commission)

On average this form takes 7 minutes to complete

The National Voter Registration Application Form For U.S. Citizens (KHM) (Election Assistance Commission) form is 4 pages long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for Election Assistance Commission

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  

 

1


 
 
   
  
    
    
  
   
  
  


 
 

 
  

  
  
  
 
 
New Hampshire 

 
 

 

  
  
 
 

 
 
  



 

    
 
  
   

  

 
 
 
 
 



 
   








 

  

 

  
  
   
    

 
  

 
 

  

  
   

  
 
 
   

   


 
 
  
 
  
 
  
 
 
 
 
 
 
   
  

   
  

  
 
 
    
   
 


 
  


  

  
    
 
   
 
   
 
 
2
 
 
  
   
   
   

  

 
 
 
 
  
  

  
 
   
 


 
 
  


 
 

 

  
    
 
 
   

 

    
  


 
 
  
 
 
  
 
 
 
  
 

 
!


 
  
   

 
 



  

 

  
 
 


 
 



  
 

     

 

 
 

 


 

  
 

 
 

 
 

 
 




  

  

 
   



 
 

   

  

  


 
 
  


 

   


  

 

 
   
  
 
 
D  


 

Before completing this form, review the General, Application, and State specic instructions.

PLEASE PROVIDE YOUR RESPONSES IN ENGLISH. / 
Are you a citizen of the United States of America?

Will you be 18 years old on or before election day?

If you checked “No” in response to either of these questions, do not complete form.

(Please see state-specic instructions for rules regarding eligibility a register prior to age 18.)

This space for oce use only. /

1
Last Name / 
First Name / 
Middle Name(s) / 
2
Home Address / Dirección donde vive Apt. or Lot # / Nº. de depto. o lote
City/Town /  State /  Zip Code / 
3
Address Where You Get Your Mail If Dierent From Above / 
City/Town /  State /  Zip Code / 
4
Date of Birth/ 
Month /  Day /  Year / 
5
Telephone Number (optional) / 
6
ID Number (See Item 6 in the instructions for your state) /
ID — 
7
Choice of Party (see item 7 in the instructions for your State) /

8
Race or Ethnic Group (see item 8 in the instructions for your State) /

9
I have reviewed my state’s instructions and I swear/arm that: / 
■ I am a United States citizen. / 
■ I meet the eligibility requirements of my state and subscribe to any oath required. / 

■ The information I have provided is true to the best of my knowledge under penalty of perjury. If I have provided
false information, I may be fined, imprisoned, or (if not a U.S. citizen) deported from or refused entry to the
United States. / 


Please sign full name (or put mark) / 
Date /

Month /  Day /  Year / 
If you are registering to vote for the rst time: please refer to the application instructions for information on submitting copies of valid identication documents with this form.


Please ll out the sections below if they apply to you.

If this application is for a change of name, what was your name before you changed it? / 
A
Last Name /  First Name /  Middle Name(s) / 
If you were registered before but this is the first time you are registering from the address in Box 2, what was your address where you were registered before?

B
Street (or route and box number) / 
Apt. or Lot # / Apt. or Lot #
City/Town/County /  State /  Zip Code / 
If you live in a rural area but do not have a street number, or if you have no address, please show on the map where you live.

C
■ Write in the names of the crossroads (or streets) nearest to where you live. / 
■ Draw an X to show where you live. / X
■ Use a dot to show any schools, churches, stores, or other landmarks near where you live, and write the name of the landmark. /

Example / 
Public School / 
•
•
Grocery Store / 
Woodchuck Road

X
NORTH / 
If the applicant is unable to sign, who helped the applicant fill out this application? Give name, address and phone number (phone number optional).

D
Mail this application to the address provided for your State.



 
Jr.Sr.IIIIIIV
 
Jr.Sr.IIIIIIV







Before completing this form, review the General, Application, and State specic instructions.

PLEASE PROVIDE YOUR RESPONSES IN ENGLISH. / 
Are you a citizen of the United States of America?

Yes

No

Will you be 18 years old on or before election day?

Yes

No

If you checked “No” in response to either of these questions, do not complete form.

(Please see state-specic instructions for rules regarding eligibility a register prior to age 18.)

This space for oce use only. /

1
Last Name / (Circle one) /
Mr. /

Mrs. /

Miss /

Ms. /

First Name / 
Middle Name(s) /  (Circle one) /

Jr. Sr. II III IV
2
Home Address / 
Apt. or Lot # / Apt. or Lot #
City/Town /  State /  Zip Code / 
3
Address Where You Get Your Mail If Dierent From Above / 
City/Town /  State /  Zip Code / 
4
Date of Birth/ 
Month /  Day /  Year / 
5
Telephone Number (optional) / 
6
ID Number (See Item 6 in the instructions for your state) /
ID — 
7
Choice of Party (see item 7 in the instructions for your State) /


8
Race or Ethnic Group (see item 8 in the instructions for your State) /


9
I have reviewed my state’s instructions and I swear/arm that: / 
■ I am a United States citizen. / 
■ I meet the eligibility requirements of my state and subscribe to any oath required. / 

■ The information I have provided is true to the best of my knowledge under penalty of perjury. If I have provided
false information, I may be fined, imprisoned, or (if not a U.S. citizen) deported from or refused entry to the
United States. / 

Please sign full name (or put mark) / 
Date /

Month /  Day /  Year / 
If you are registering to vote for the rst time: please refer to the application instructions for information on submitting copies of valid identication documents with this form.


Please ll out the sections below if they apply to you.

If this application is for a change of name, what was your name before you changed it? / 
A
Mr. /
Mrs. / 
Miss / 
Ms. / 
Last Name /  First Name /  Middle Name(s) / 
(Circle one) /

Jr. Sr. II III IV
If you were registered before but this is the first time you are registering from the address in Box 2, what was your address where you were registered before?

B
Street (or route and box number) / 
Apt. or Lot # / Apt. or Lot #
City/Town/County /  State /  Zip Code / 
If you live in a rural area but do not have a street number, or if you have no address, please show on the map where you live.

C
■ Write in the names of the crossroads (or streets) nearest to where you live. / 
■ Draw an X to show where you live. / X
■ Use a dot to show any schools, churches, stores, or other landmarks near where you live, and write the name of the landmark. /

Example / 
Public School / 
•
•
Grocery Store / 
Woodchuck Road

X
NORTH / 
If the applicant is unable to sign, who helped the applicant fill out this application? Give name, address and phone number (phone number optional).

D
Mail this application to the address provided for your State.







3
រណែំរដ

 

  
 
 
  
    
  
 
 

  
  

 
  



 
 


 






 



  





 
  



  
 


 

 


 
 

 
 





  



 
 

  
  
 
 





 
  




 
 




 

 
 
  

  


 
  
 
  



   
  
 


 
  

 
 

  




  



 

 
 
  

  

  
  
 
 
 




  


 
    
 
 
 
 

 

 
  

 





 

 
 
  
  

 
   

  
 

 
  
 
 



 
  
4
រណែំរដ

 
 



 

  
   

 


 
 
 

 



  



 
 
  
 
  

 






 
 



 

 
 
  
  

 
 
 
  



 
  

 
 






 



  




  



 
  
 
 
  
 
 

 
  

 

 

 

 



 

 
  
   
 
 
  

 

  


  
 
   


 
 


 


  




  

 

 
 

  
  



  
  




 

 







 
 
 





 
 




 
  



 

 
  
 
 
   
   

 


  

5
រណែំរដ



 
 
 

 



 

 
 


 
 
 
  
 
 
 
 
  


 
 

 
 




 



 





   



  
 
 


 


 




 
 

 

 
 
 


 

 



 

 



  



  


 

 

 
 
 

 
 








 


  
 
 






 

  

 
 
  
  

 
 
 
  



 
  

 
 




 



 





   

 
 
 
 
 
 
  
 


 

 


  
 
 

 
 
6
រណែំរដ

 
 

 


 
  

  





 
 


  
  

  

  
   

 
 
 
  

 

 
 

 



 

 
 
 



  
  
 
  
 
 
  

 
 


 



 





  



  
   
 
 

 
  


  
  
  
   
 
  
  

  
 
 
 



 
 
  
 

 
 



 


 
 
 
 

  
  
 
  


 

 

 

 



 




 

  
  
 
  



 
 

 
 

  


 
  


 

 





 

  
  
  
  
 
  

 



 




 

 
 
7
រណែំរដ
  

 

 
   
 

 

 
 


  

 
  

 
  



 

 





   
 

  



 
 

  




   
 

  


 
  
  
    

 
  
 
 
 

 


 






 
 
 
 
  

 
   


 
   


  



 
 

 
  



  






  
  


 
  
   

 
 
 


 


 
 




 

 
 
 
  
 
 



 


  




  


 
  
 
  
 
 


 

 





 
 
 

  

 
  


 
 
 
 






   



 
  
  
   



  


  
 


   
 
 







 


8
រណែំរដ
  

 
  
 
  
   
  
 
  

 
  
 
  
 
 

  



   
 
 
 
 
 

 
 
 
 
 

 



 

 
 
  
   
 

 
  



 

 



  



  
  
 
  


 
 
 





 

 
  
  
 
 

 
 
 




  
 
  
 

.
  
  

   






 

 

 


 




  

 
  




  




 


 

 




  

 


 

 
 


 


 

 


  
  

 
 
 
  



 
  

 
 





 


9
រណែំរដ

 



 
 



  





  
 

 

 
 
 

 

 





 

 
 
  




 

 



 
 

 



 
 



  




  
 
 
 
  

  
 






 

 


 

 



 

 
 
  

 
  






   
 
   
 
 


 

 


 
 
 
  
  




 
   


 
 
  


 

 
 


  



  




  
 



 

 



 
  
 


 
 
 
  
   

 
  


 
 




 
 

 

 
 


10
រណែំរដ
  


  
 

 



  



 

 


   
 
  
  

 

 





   

 



 
 





  



 

 
 


 
 
 

 



 

 
 
  
 
 
 
   
 
 
 



 
  
  
    
  
 
 

 
 
 

 

 



 



  



  
  
  
 
 

 


 




 

 

 



 
 
 
  

 
  
 





  
 




 

 
 


  
  
 



  



  

  

  
 
 
 

 
 



 

 



 

 
 
 
11
រណែំរដ
  
 
 
 
  
 

 
 
  
 
 

 

    




 
   


 
 





 
 



 


 
 
  
 
 
 
 


 


 

 
 

  
   



 
  
 
 
   


 

 

 
 


   




  





 



 

 

   
 
   
  

 
   
  
  





 
 



  



 
  
  

 
 
 
 




 
 

 




  

 




 

 
 
  


  





 


 



  




  



 
 

 

  


 
  
















 
 


  
  
 
12
រណែំរដ
  
 
 



  
 
  

  



 

 
 
  
  

 
  




 


 





 



 



 



  




  




 


 

 


 

  

 







 




 

 
  

 
  
  

 

  
  
 
 
 

 

 

 


 

 
 

 



  
 
  
 

 
 

 


 
 
    



  

 




  



  
  
 
  
  

  
 




 
    
 

 
  

 
  





  
 

  



13
រណែំរដ
  

  

 
  

 
 




 

 
 
   
 
  
 

 





 



 




  




   
 
 
 



 


  
 
 



  
 




 
 
 
 

 

 
   


 
 

  
  
  


 

 
 
  
  
   
 
   

 
  



 
  



  
 
 


 



 
 
 

 
  
 



  




  
   
  
   
  
 



 


 
  

 
 
  


   

 
  
 

 

 

 





 

 



  
  

 



 

 


14
រណែំរដ

 

 

  
 
  
  
 
 


  

 
 
  
 
 


 

  

 
   
 

 

 




 

 

 

 
 
 




 

 


 


 

 

 

 
 
  


 

 
 
  
 

 

 

  


  
  



  
 
 

 
 
 

 
 


 
 
 



  



 
  
  
 
  

 



 



 



 

 
 
  


  
 

  


  
  

 
 


  
  
  


 
  

 

 
 

 



 




  



  

  



 

  
 



 
 
15
រណែំរដ



 

 
 
  


 
  
 





 
 



 



 



  



  

 

 
 
 
  
  
 






 

 

 



 

 
 
   
  
  
 
 

 


 



 
 

  
 

 
  

  



   
  




  
 
  



 
   

 
  



 

 
 
 

 



 


  

 

 
 
  



  
 
 
 



 
  
 






 







 


 



  




 
 

 
  
 







 

 

16
រណែំរដ


 
 
 
  


 
 

  

  



 



  
  


 


 

  







  

  
 
   
 

 






 


 
 

 
 
   
 
 




 


  
 

  
 

 



 
 
 
 
 



 
  




  




  

 

 




 

 
 
  


 
  
 






 
 




 



 



  




 

 

 



 
 
 
 
 

 

 




  
   

 


  




   
  
 

  


  

  
  

  

 
  
 




 
 
17
រណែំរដ

 
 
 
  

 

  
 


 
 
 

   
 







 




 
 




 
 
 
 

  


  
 
 


   

 




  



 
  
 


 
 


 





 


 



 

 
 
  







  

 


  




 


  




   
 


  
 

  



  
  
 


 




 
 
  
  


 

 

 
 
  
 
 
 
 



 

 
 
   



 




 



 




  



  

 
 

 

 



 
 
 


18
រណែំរដ

 
 
 
  






  



 



  



 




  
  

 

 

  


  

 




 






 



 

 




 

 
 
  

  
  





 
 





 



  




  



   
  
  


 

 

 
  







  

 

 



 
  
  
   
 
 


 
 
   
  
 
  

 


  


  
    
 
  
   
  


 

  

 


  
 
  
 
  


 


  
  
 


 


 




  



19
រណែំរដ
 

   
  
  

   

  
 
 
   



 
 

 




 

 
  
  
 




 
 
 
 
 
 

 



 


  
  


  


 





 


 
  

 
  
   
  

   

  
 
 
   
 

 
 
 

 


 

 

  
  
  
 





 
 


 
  



  

 
   
 
 

 




  



 
 
 

  

 




 
 






 
 
  
 

 
 
  

  
 
  
 
  
 
 



 

 


  
 
20
រណែំរដ




 







 
  
 
 
 
 

 



 
 

   

 
 





 

 
 
 
  
 



 
 
 

 



 
 
 
 



  



 
 
 
 

 


 

  

 




 

 





 

 
 
 
  

 
   
 
   

 
  


  
  
  


  
  

 


  



   






 

  
.
  
 
  




 
  

 



  








 


 

   

  

 
  




  





 

 


 
 


  

  
  
 

 
  
 

 



21
រណែំរដ

  

  








 
 
 



 


 
  

 

 

 




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National Voter Registration Application Form For U.S. Citizens (KHM) (Election Assistance Commission)

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Completed 10 August 2020

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