2014 New Hampshire Revised Statutes
Title LXIII - ELECTIONS
Chapter 659 - ELECTION PROCEDURE
Section 659:13-b - Affidavit of Religious Exemption.

[RSA 659:13-b effective September 1, 2015.]     659:13-b Affidavit of Religious Exemption. –
    The affidavit of religious exemption shall be in the following form:

 AFFIDAVIT OF RELIGIOUS EXEMPTION 
Name: ____________________ 
Domicile Address: ____________________ 
Date of birth: _______________ 
I hereby swear or affirm that because of my religious beliefs, I object to 
 having my photograph taken and that I do not possess a form of identification
 that meets the requirements of the election laws of this state showing my 
 photograph. 
I hereby swear or affirm, under the penalties for voting fraud set forth below,
 that I am the identical person whom I represent myself to be and that to the 
 best of my knowledge and belief the information above is true and correct. 
 _________________________ 
 (Signature of affiant) 
In accordance with RSA 659:34, the penalty for knowingly or purposely providing
 false information when 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. 
This affidavit was executed before us on the date shown and the person who 
 subscribed his or her name to the foregoing affidavit swore that the facts 
 contained in this affidavit are true to the best of his or her knowledge and 
 belief. 
 ____________________ ____________________ 
 (Name of Election Officer) (Date) 
 ____________________ 
 (Signature of Election Officer) 

Source. 2012, 284:11, eff. Sept. 1, 2015.