Last Name
First Name Middle Initial
Date of Birth (month) (day) (year)
New Jersey Residence:
Street Apt. No.
Municipality
County Zip Code
Signature or mark of registered voter Date
State of New Jersey
Political Party Afliation Declaration Form
State of New Jersey
Department of State
Division of Elections
NJ Division of Elections - 7/03/14
elections.nj.gov
*If you are a registered member of the Green Party, Libertarian Party, Natural Law Party, Reform
Party, U.S. Constitution Party, Socialist Party of New Jersey or the Conservative Party, you can
participate in the convention of that party, according to its bylaws, but you cannot vote in either
the Democratic or Republican Primary.
**If you are a previously afliated voter who becomes unafliated, you must le the declaration
form no later than 55 days before the primary in order to vote in either primary.
Declaration must be led no later than 55 days preceding the primary in which the voter wishes
to vote. An unafliated voter can afliate with the Democratic or Republican Party on the day
of the primary.
I, being a registered voter at the address listed below, do hereby declare that I wish
to afliate with the following political party or political group:
OR
I, being a registered voter at the address listed below, do hereby declare that I do
not want to be afliated with any political party or group.
q
Democratic
q
Republican
q
Conservative*
q
Green*
q
Libertarian*
q
Natural Law Party*
q
Reform Party*
q
U.S. Constitution Party*
q
Socialist Party of New Jersey*
q Unafliated**
