Clear Form
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
pre-register to vote if you are 16 or 17 years of age
To register you must:
be a US citizen;
be 18 years old (you may pre-register at 16
or 17 but cannot vote until you are 18);
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 therst time.
中文資料:若您有興趣索取中文資料表格,
請電: 1-800-367-8683

1-800-367-8683 
Información en español: si le interesa obtener este
formulario en español, llame al 1-800-367-8683
한국어: 한국어 양식을 원하시면
1-800-367-8683 으로 전화 하십시오.
It is a crime to procure a false registration or to furnish false information to the Board of Elections.
Please print in blue or black ink.
Are you a citizen of the U.S.?
Yes No
1
If you answer No, you cannot register to vote.
For board use only
Qualications
2
Yes No
A) Will you be 18 years of age or older on or before election day?
B) Are you at least 16 years of age and understand that you must be 18 years of
age on or before election day to vote, and that until you will be eighteen years of
age at the time of such election your registration will be marked “pending” and you
will be unable to cast a ballot in any election?
Yes No
If you answer No to both of the prior questions, you cannot register to vote.
Last name Sufx
Your name
3
First name Middle Initial
/ /
M M D D Y Y Y Y
5
Gender
4
Birth date
More information
Items 5, 6 & 7 are optional
6
Phone
7
Email
Address (not P.O. box)
The address
where you live
8
Apt. Number
City/Town/Village
New York State County
Zip code
The address where
you receive mail
Skip if same as above
9
Address or P.O. box
P.O. Box
City/Town/Village
Zip code
Have you voted before? Yes No
11
What year?
Voting history
10
Your name was
Voting information
that has changed
12
Your address was
Skip if this has not changed
or you have not voted before
Your previous state or New York State County was
New York State DMV number
You must make 1 selection
Identication
13
Last four digits of your Social Security number
xxx xx
For questions, please refer to
Verifying your identity above.
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 pa
rty
R
ep
u
b
lican pa
rty
Conservative party
Working Families party
Other
I do not want to enroll in any political party
and wish to be an independent voter
No party
Afdavit: I swear or afrm that
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
I need to apply for an Absentee ballot.
Optional questions
15
16
Date
I would like to be an Election Day worker.
Rev. 12/03/2020
Clear Form
Select your New York State County
Address and stamp this section
Place
First-Class
Stamp
Here
Your address
Your County Board of Elections address (select from below)
Before mailing,
remove tape,
fold and seal
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.
(Optional) Register to donate your organs and tissues
New York City
32 Broadway, 7th Fl.
New York, NY 10004
(212) 487-5300
Albany
260 S. Pearl St.
Albany, NY 12202
(518) 487-5060
Allegany
8 Willets Ave.
Belmont, NY 14813
(585) 268-9294
Broome
Government Plaza
60 Hawley St.
PO Box 1766
Binghamton, NY
13902
(607) 778-2172
Cattaraugus
207 Rock City St.
Suite 100
Little Valley, NY 14755
(716) 938-2400
Cayuga
157 Genesee St.
(Basement)
Auburn, NY 13021
(315) 253-1285
Chautauqua
7 North Erie St.
Mayville, NY 14757
(716) 753-4580
Chemung
378 South Main St.
PO Box 588
Elmira, NY 14902
(607) 737-5475
Chenango
5 Court St.
Norwich, NY 13815
(607) 337-1760
Clinton
Cnty Government Ctr.
Ste. 104
137 Margaret St.
Plattsburgh, NY 12901
(518) 565-4740
Columbia
401 State St.
Hudson, NY 12534
(518) 828 -3115
Cortland
112 River St.
Suite 1
Cortland, NY 13045
(607) 753-5032
Delaware
3 Gallant Ave.
Delhi, NY 13753
(607) 832-5321
Dutchess
47 Cannon St.
Poughkeepsie, NY
12601
(845) 486-2473
Erie
134 W. Eagle St.
Buffalo, NY 14202
(716) 858-8891
Essex
7551 Court St.
PO Box 217
Elizabethtown, NY
12932
(518) 873-3474
Franklin
355 West Main St.
Ste. 161
Malone, NY 12953
(518) 481-1663
Fulton
2714 St. Hwy 29
Ste. 1
Johnstown, NY 12095
(518) 736-5526
Genesee
County Building #1
15 Main St.
Batavia, NY 14020
(585) 815-7804
Greene
411 Main St.
Ste. 437
Catskill, NY 12414
(518) 719-3550
Hamilton
Rte. 8
PO Box 175
Lake Pleasant, NY
12108
(518) 548-4684
Herkimer
109 Mary St.
Ste. 1306
Herkimer, NY 13350
(315) 867-1102
Jefferson
175 Arsenal St.
Watertown, NY 13601
(315) 785-3027
Lewis
7660 N. State St.
Lowville, NY 13367
(315) 376-5329
Livingston
County Govt. Ctr.
6 Court St.
Room 104
Geneseo, NY 14454
(585) 243-7090
Madison
County Office Bldg.
N. Court St.
PO Box 666
Wampsville, NY
13163
(315) 366-2231
Monroe
39 Main St. W.
Rochester, NY 14614
(585) 753-1550
Montgomery
Old Courthouse
9 Park St.
PO Box 1500
Fonda, NY 12068
(518) 853-8180
Nassau
240 Old Country Rd.
5th Fl.
PO Box 9002
Mineola, NY 11501
(516) 571-8683
Niagara
111 Main St.
Ste. 100
Lockport, NY 14094
(716) 438-4040
Oneida
Union Station
321 Main St.
3rd Fl.
Utica, NY 13501
(315) 798-5765
Onondaga
1000 Erie Blvd West
Syracuse, NY 13204
(315) 435-3312
Ontario
74 Ontario St.
Canandaigua, NY
14424
(585) 396-4005
Orange
75 Webster Ave
PO Box 30
Goshen, NY 10924
(845) 360-6500
Orleans
14016 Route 31 West,
Ste. 140
Albion, NY 14411
(585) 589-3274
Oswego
185 E. Seneca St.
Box 9
Oswego, NY 13126
(315) 349-8350
Otsego
Ste. 2
140 County Hwy. 33W
Cooperstown, NY
13326
(607) 547-4247
Putnam
25 Old Route 6
Carmel, NY 10512
(845) 808-1300
Rensselaer
Ned Pattison
Government Ctr.
1600 Seventh Ave.
Troy, NY 12180
(518) 270-2990
Rockland
11 New Hempstead Rd.
New City, NY 10956
(845) 638-5172
St. Lawrence
80 State Hwy 310
Canton, NY 13617
(315) 379-2202
Saratoga
50 W. High St.
Ballston Spa, NY
12020
(518) 885-2249
Schenectady
2696 Hamburg St.
Schenectady, NY
12303
(518) 377-2469
Schoharie
County Office Bldg.
284 Main St.
PO Box 99
Schoharie, NY 12157
(518) 295-8388
Schuyler
County Office Bldg.
105 9th St., Unit 13
Watkins Glen, NY
14891
(607) 535-8195
Seneca
One DiPronio Dr.
Waterloo, NY 13165
(315) 539-1760
Steuben
3 E. Pulteney Sq.
Bath, NY 14810
(607) 664-2260
Suffolk
Yaphank Ave.
PO Box 700
Yaphank, NY 11980
(631) 852-4500
Sullivan
Govt. Ctr.
100 North St.
PO Box 5012
Monticello, NY 12701
(845) 807-0400
Tioga
1062 State Rte. 38
PO Box 306
Owego, NY 13827
(607) 687-8261
Tompkins
Court House Annex
128 E. Buffalo St.
Ithaca, NY 14850
(607) 274-5522
Ulster
284 Wall St.
Kingston, NY 12401
(845) 334-5470
Warren
Cnty. Municipal Ctr.
3rd Floor
Human Serv. Bldg
1340 St. Rte. 9
Lake George, NY
12845
(518) 761-6456
Washington
383 Broadway
Fort Edward, NY
12828
(518) 746-2180
Wayne
7376 State Rte. 31
PO Box 636
Lyons, NY 14489
(315) 946-7400
Westchester
25 Quarropas St.
White Plains, NY
10601
(914) 995-5700
Wyoming
4 Perry Ave.
Warsaw, NY 14569
(585) 786-8931
Yates
Ste. 1124
417 Liberty St.
Penn Yan, NY 14527
(315) 536-5135
Last name
First name
Sufx
Middle Initial
Address
Zip code
Apt. Number
City
M M D D Y Y Y Y
Gender M F
Birth date
/ /
Eye color Height
Ft. In.
DMV or ID NYC #
Email
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.
Sign Date
Nassau County Board of Elections
P.O. Box 9002
Mineola, NY 11501