2015 New Hampshire Revised Statutes
Title LXIII - ELECTIONS
Chapter 654 - VOTERS AND CHECKLISTS
Section 654:17 - Absentee Registration Affidavit.

    654:17 Absentee Registration Affidavit. –
    I. The absentee registration affidavit shall be prepared by the secretary of state and shall be in substantially the following form:
    I, __________________ do hereby swear or affirm, under the penalties for voting fraud set forth below, the following:
    1) That my legal domicile is in the town of _______________, New Hampshire, I will be of the age of 18 years or over on election day and am entitled to vote in the election to be held in said town on _______________, _________ (date), except for the fact that my name does not appear on the checklist to be used in said town at such election;
    2) That I do not intend to be present within said town at such time prior to said election as shall enable me personally to appear before the supervisors of the checklist of said town in their regular sessions for the correction of the checklist for said election;
    3) That I am temporarily residing in __________ (city and state or city, province, and country);
    4) That I hereby enclose one of the following as proof of identity and domicile:
       (a) A copy of a current and valid New Hampshire driver's license or an armed services identification or other photo identification issued by the United States government that shows my name and address; or
       (b) A copy of a current and valid photo identification and a copy of a current utility bill, bank statement, government check, paycheck, other government document that shows my name and address, or a letter from the administrator of a nursing home or similar facility affirming that I am a resident of that facility that was provided to me at my request pursuant to the administrator's duty to provide such a letter upon my request;
    5) That I acknowledge that if I do not provide a copy of proof of identity and domicile as required by section 4) above, this application may not be approved; and
    6) That I hereby make application for the addition of my name to the checklist of said town to be used at said election.

 ____________________ 
 Signature of Applicant 
 
 ____________________ 
 Date 

    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.
    I, _____________________ do hereby swear or affirm, under the penalties for voting fraud set forth below, the following:
    1) That my legal domicile is in the town of ________________, New Hampshire, I will be of the age of 18 years or over on election day, and am entitled to vote in the election to be held in said town on ________________, ___ (date), except for the fact that my name does not appear on the checklist to be used in said town at such election;
    2) That I am unable by reason of physical disability personally to appear before the supervisors of the checklist of said town in their regular sessions for the correction of the checklist for said election;
    3) That I hereby enclose one of the following as proof of identity and domicile:
       (a) A copy of a current and valid New Hampshire driver's license or an armed services identification or other photo identification issued by the United States government that shows my name and address; or
       (b) A copy of a current and valid photo identification and a copy of a current utility bill, bank statement, government check, paycheck, other government document that shows my name and address, or a letter from the administrator of a nursing home or similar facility affirming that I am a resident of that facility that was provided to me at my request pursuant to the administrator's duty to provide such a letter upon my request;
    4) That I acknowledge that if I do not provide a copy of proof of identity and domicile as required by section 3) above, this application may not be approved; and
    5) That I hereby make application for the addition of my name to the checklist of said town to be used at said election.

 ____________________ 
 Signature of Applicant
 
 ____________________ 
 Date 

    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.
    II. There shall be printed below each of the foregoing affidavits the following affirmation:
    I, __________, the undersigned witness, do hereby swear or affirm, under the penalties for voting fraud set forth below, that on the __________ day of __________, ___ (date), the above named, __________, having satisfied me as to his or her identity, signed the foregoing affidavit in my presence, and did before me swear to (or affirm) the truth of the statements therein contained.

 ____________________
 Signature of Witness

    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. 1995, 124:1. 2003, 289:30. 2004, 229:3, eff. Aug. 10, 2004.