(a)
Standard registration application forms shall be used throughout the state. The registration forms shall be no larger than 8 1/2 inches by 11 inches.
(b)
The secretary of state shall prescribe the form of the voter registration form to be used for voter registrations, transfers, or updates other than those used within 30 days of an election or at the polling place on election day, which shall be in substantially the following form:
___ NEW REGISTRATION I am not registered to vote in New Hampshire
___ TRANSFER I am registered to vote in New Hampshire and have moved my voting domicile to a new town or ward in New Hampshire
___ NAME CHANGE/ADDRESS UPDATE I am registered to vote in this town/ward and have changed my name/address
Date
____________________
VOTER REGISTRATION FORM
(Please print or type)
1. Name
Last (suffix) First Full Middle Name
2. Domicile Address
Street Ward Number
Town or City Zip Code
3. Mailing Address if different than in 2
Street
Town or City Zip Code
4. Place and Date of Birth
Town or City State
Date
____________________
5. Are you a citizen of the United States? Yes
_____ No
_____
If a naturalized citizen, give name of court where and date when naturalized
6. Place last registered to vote
Street Ward Number
I am not currently registered to vote elsewhere (initial here __________), or I request that my name be removed as a registered voter in ______________________________ (fill in your address where previously registered, street, city/town, state, and zip code)
7. Name under which previously registered, if different from above
8. Party Affiliation (if any)
9. Driver's License Number
_________________________State
If you do not have a valid driver's license, provide the last four digits of your social security number __________
My name is ____________________. I am today registering to vote in the city/town of ____________________, New Hampshire. If a city, ward number __________.
I understand that to vote in this ward/town, I must be at least 18 years of age, I must be a United States citizen, and I must be domiciled in this ward/town.
I understand that a person can claim only one state and one city/town as his or her domicile at a time. A domicile is that place, to which upon temporary absence, a person has the intention of returning. By registering or voting today, I am acknowledging that I am not domiciled or voting in any other state or any other city/town.
In declaring New Hampshire as my domicile, I realize that I am not qualified to vote in the state or federal elections in another state.
If I have any questions as to whether I am entitled to vote in this city/town, I am aware that a supervisor of the checklist is available to address my questions or concerns.
I acknowledge
that I have read and understand the above qualifications
for voting and do hereby swear, under the penalties for voting fraud set forth below, that I am qualified to vote in the above-stated city/town, and, if registering on election day, that I have not voted and will not vote at any other polling place this election.
Date
Signature of Applicant
In accordance with
RSA
659:34
, the penalty for knowingly or purposely providing false information when registering to vote or voting is a class A misdemeanor with a maximum sentence of imprisonment not to exceed one year and a fine not to exceed $2,000. Fraudulently registering to vote or voting is subject to a civil penalty not to exceed $5,000.
(c)
The secretary of state shall prescribe the form of the voter registration form to be used only for voter registrations, transfers, or updates starting 30 days before each election and at the polling place on election day, which shall be in substantially the following form:
___ NEW REGISTRATION I am not registered to vote in New Hampshire
___ TRANSFER I am registered to vote in New Hampshire and have moved my voting domicile to a new town or ward in New Hampshire
___ NAME CHANGE/ADDRESS UPDATE I am registered to vote in this town/ward and have changed my name/address
Date registration form is submitted
_______________
Date applicant moved to the address listed below as the voter's domicile
__________
VOTER REGISTRATION FORM
FOR USE STARTING 30 DAYS BEFORE AN ELECTION AND AT THE POLLING PLACE ON ELECTION DAY
(Please print or type)
1. Name
Last (suffix) First Full Middle Name
2. Domicile Address
Street Ward Number
Town or City Zip Code
3. Mailing Address if different than in 2
Street
Town or City Zip Code
4. Place and Date of Birth
Town or City State
Date
____________________
5. Are you a citizen of the United States? Yes
_____ No
_____
If a naturalized citizen, give name of court where and date when naturalized
6. Place last registered to vote
Street Ward Number
I am not currently registered to vote elsewhere (initial here __________), or I request that my name be removed as a registered voter in ______________________________ (fill in your address where previously registered, street, city/town, state, and zip code)
7. Name under which previously registered, if different from above
8. Party Affiliation (if any)
9. Driver's License Number
_________________________State
If you do not have a valid driver's license, provide the last four digits of your social security number __________
My name is ____________________. I am today registering to vote in the city/town of ____________________, New Hampshire. If a city, ward number __________.
I understand that to vote in this ward/town, I must be at least 18 years of age, I must be a United States citizen, and I must be domiciled in this ward/town.
I understand that a person can claim only one state and one city/town as his or her domicile at a time. A domicile is that place, to which upon temporary absence, a person has the intention of returning. By registering or voting today, I am acknowledging that I am not domiciled or voting in any other state or any other city/town.
In declaring New Hampshire as my domicile, I realize that I am not qualified to vote in the state or federal elections in another state.
If I have any questions as to whether I am entitled to vote in this city/town, I am aware that a supervisor of the checklist is available to address my questions or concerns.
I understand that to make the address I have entered above my domicile for voting I must have an intent to make this the one place from which I participate in democratic self-government and must have acted to carry out that intent.
I understand that if I have documentary evidence of my intent to be domiciled at this address when registering to vote, I must either present it at the time of registration or I must place my initials next to the following paragraph and mail a copy or present the document at the town or city clerk's office within 10 days following the election (30 days in towns where the clerk's office is open fewer than 20 hours weekly).
_____ By placing my initials next to this paragraph, I am acknowledging that I have not presented evidence of actions carrying out my intent to be domiciled at this address, that I understand that I must mail or personally present to the clerk's office evidence of actions carrying out my intent within 10 days following the election (or 30 days in towns where the clerk's office is open fewer than 20 hours weekly), and that I have received the document produced by the secretary of state that describes the items that may be used as evidence of a verifiable action that establishes domicile.
Failing to report and provide evidence of a verifiable action will prompt official mail to be sent to your domicile address by the secretary of state to verify the validity of your claim to a voting domicile at this address.
I understand that if I do not have any documentary evidence of my intent to be domiciled at this address, I must place my initials next to the following paragraph:
_____ By placing my initials next to this paragraph, I am acknowledging that I am aware of no documentary evidence of actions carrying out my intent to be domiciled at this address, that I will not be mailing or delivering evidence to the clerk's office, and that I understand that officials will be sending mail to the address on this form or taking other actions to verify my domicile at this address.
I acknowledge
that I have read and understand the above qualifications
for voting and do hereby swear, under the penalties for voting fraud set forth below, that I am qualified to vote in the above-stated city/town, and, if registering on election day, that I have not voted and will not vote at any other polling place this election.
Date
Signature of Applicant
If this form is used in place of proof of identity, age, or citizenship, I hereby swear that such information is true and accurate to the best of my knowledge.
This form was executed for purposes of proving (applicant shall circle yes or no and initial each item):
Identity yes/no
_____
(initials)
Citizenship yes/no
_____
(initials)
Age yes/no
_____
(initials)
Applicant
Election Official
Notary Public/Justice of the Peace/Official Authorized by
RSA
659:30
In accordance with
RSA
659:34
, the penalty for knowingly or purposely providing false information when registering to vote or voting is a class A misdemeanor with a maximum sentence of imprisonment not to exceed one year and a fine not to exceed $2,000. Fraudulently registering to vote or voting is subject to a civil penalty not to exceed $5,000. In accordance with
RSA
659:34-a
voting in more than one state in the same election is a class B felony with a maximum sentence of imprisonment not to exceed 7 years and a fine not to exceed $4,000.