Fillable Form New York Voter Registration Application

What is the New York Voter Registration form?

The New York Voter Registration form is a state-specific legal form that enables New York residents to register to vote. Aside from its use as an application form, New York residents may also submit it to change their name or address on their voter registration, register to become a member of a political party, or change their party membership.

Not every New York resident can register to vote. There are definite conditions that a resident should meet to determine if he or she is eligible to register to vote. If you wish to register to vote, you must:

• be a U.S. citizen;
• be 18 years old and above by the end of this year;
• 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; and
• not found to be incompetent by a court.

The registration deadline is 25 days before the election day.

How to fill out the New York Voter Registration form?

The New York Voter Registration form is a two-page form that requires your personal information and voter-related questions that may be applicable.

First Page

Item 1 — Are you a citizen of the U.S.?

Mark Yes is you are a citizen of the U.S.; otherwise, mark No. If you answer No, you cannot register to vote.

Item 2 — Will you be 18 years of age or older on or before election day?

Mark Yes if you will be 18 or above on or before election day; otherwise, mark No.

Item 3 — Last Name, First Name, Suffix, Middle Initial

Enter your full legal name.

Item 4 — Birth date

Enter your birth date in the following format: MM/DD/YYYY.

Item 5 — Gender

Enter your gender.

Item 6 — Phone

Enter your phone number.

Item 7 — Email

Enter your email address.

Item 8 — Address, Apt. Number, City/Town/Village, ZIP Code

Enter the full address where you live.

Item 9 — Address of P.O. box, Apt. Number, City/Town/Village, ZIP Code

Enter the address where you want to receive your mail. You may skip this item if it is the same as Item 8.

Item 10 — Have you voted before?

Mark Yes if you have voter before; otherwise, mark No.

Item 11 — What year?

If you have voted before, write the year.

Item 12 — Your name was, Your address was, Your previous state or New York Country was

Enter your previous legal name, your previous address, or your previous state or New York Country if any of them has changed. You may skip this item if there was no change or you have not voted before.

Item 13 — New York State DMV number, Last four digits of your Social Security number, I do not have a New York State driver’s license or a Social Security number

Enter your New State DMV number and the last four digits of your Social Security number. If you do not have a New York State driver’s license or a Social Security number, mark the applicable box.

Item 14 — I wish to enroll in a political party, I do not want to enroll in any political party and wish to be an independent voter

If you wish to enroll in any political party, mark the box of the political party you wish to be a member of. You can select from one of the following:

• Democratic party
• Republic party
• Conservative party
• Working Families party
• Green party
• Libertarian party
• Independence party
• SAM party
• Other (specify)

On the other hand, if you do not want to enroll in any political party and wish to be an independent voter, mark the No Party box.

Note: Political party enrollment is optional bu that, in order to vore in a primary election of a political party, a voter must enroll in that political party, unless state party rules allow otherwise.

Item 15 — I need to apply for an Absentee ballot, I would like to be an Election Day worker

Mark the appropriate box that applies. This item is optional.

Item 16 — Affidavit

Sign and date the form if you swear and affirm that

• you are a citizen of the United States;
• you have lived in the county, city, or village for at least 30 days before the election;
• you meet all requirements to register to vote in New York states;
• it is your signature or mark in the signature box; and
• all the information you provided is true and you understand that if it is not true, you can be convicted and fined up to $5,000 and/or jailed for up to four years.

Second Page

Your address

Enter your full address.

Your County Board of Elections address

Enter your County Board of Elections address. You may refer to the addresses in the form for the address.

Register to donate your organs and tissues

This section is optional. If you would like to be an organ and tissue donor upon your death, you may enroll in the NYS Donate Life Registry online or complete the section. You will receive a confirmation email or letter, which will also provide you an opportunity to limit your donation.

Name

Enter your full legal name, including your Last Name, First Name, Middle Initial, and Suffix.

Address

Enter your full address, including the Apt. Number, City, and ZIP Code.

Birth date

Enter your birth date.

Gender

Select M if you are male and F if you are female.

Eye color

Enter your natural eye color.

Height

Enter your height in feet and inches.

Email

Enter your email address.

DMV or ID NYC#

Enter your DMV number or your NYC ID number.

Date and sign the section to certify that you are

• 16 years of age or older;
• consenting to donate all of your organs and tissues for the 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 your 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.