STATE OF NEW HAMPSHIRE
APPLICATION TO CHANGE PARTY AFFILIATION
Print Legibly
Town/City of _____________________________________ City Ward____________
enter town/city name
Voter: ______________________________________________________________________
First Name Middle Name Last Name Suffix
Domicile/Residence Address: ____________________________________________________
Street
________________________________________ __________________
Town/City Date-of-Birth
I am currently registered as affiliated with the _________________________ party.
Fill in Party Name
I apply to change my party affiliation to (check one):
DEMOCRAT
REPUBLICAN
I declare that I affiliate with and generally support the candidates of the party chosen above.
______________________________________________ Date _______________
Voter Signature. Signed under the pains and penalties of perjury
OR
UNDECLARED
I do not wish to be registered as a member of any party.
______________________________________________ Date _______________
Voter Signature. Signed under the pains and penalties of perjury
Witness Signature is Required
I witnessed the voter listed on this form sign this form. I know this voter or he/she proved
his/her identity to me:
Print Witness Name _____________________________________________
Witness Signature: ___________________________________________ Date ____________
The completed and signed application must be returned to the town or city clerk by US
Mail, Fax, e-mail attachment, or drop off no later than 5:00 PM on Tuesday June 2, 2020.
For Official Use Only Entered into ElectioNet: Date____________
Supervisor/Clerk Initials:________
Executive Order #43 - Temporary Modification to Requirements for Change of Party Affiliation – Issued May 13, 2020
