2010 New Hampshire Statutes
TITLE LXIII ELECTIONS
CHAPTER 654 VOTERS AND CHECKLISTS
Section 654:7 Voter Registration Form.

654:7 Voter Registration Form. – A standard registration application form shall be used throughout the state. The registration form shall be no larger than 8 1/2 inches by 11 inches. The secretary of state shall prescribe the form of the voter registration form, which shall be in substantially the following form:

Date ______________________________

VOTER REGISTRATION FORM (Please print or type)

1. Name ____________________ Last (suffix) First Full Middle Name

2. Address ____________________ Street Ward Number ____________________ Town or City Zip Code

3. Mailing Address if ____________________ different than in 2 Street Ward Number ____________________ Town or City Zip Code

4. Place and Date of Birth ____________________ Town or City State Date ____________________ 5. If a naturalized citizen, give name of court where and date when naturalized ____________________ 6. Place last registered to vote ____________________ Town or City

____________________ Street Ward Number 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.
    I understand that to vote in this city/town, I must be at least 18 years of age, I must be a United States citizen, and I must be domiciled in this city/town.
    I understand that I can claim only one city/town as my domicile at a time. A domicile is that place, more than any other, where I sleep most nights of the year, or to which I intend to return after a temporary absence. By registering or voting today, I acknowledge that I am not registering to vote or voting in any other city/town.
    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
    In accordance with RSA 659:34, the penalty for knowingly or purposefully 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.

Source. 1979, 436:1; 373:1. 1983, 475:1. 1990, 119:1. 1998, 194:2. 2003, 289:25. 2007, 10:1. eff. July 1, 2007.