2015 New Hampshire Revised Statutes
Title LXIII - ELECTIONS
Chapter 654 - VOTERS AND CHECKLISTS
Section 654:7 - Voter Registration; Voter Registration Form.

    654:7 Voter Registration; Voter Registration Form. –
    I. Any person registering to vote shall be:
       (a) At least 18 years of age on the day of the election; and
       (b) A United States citizen; and
       (c) Domiciled in the town or city in which the applicant is registering to vote and not otherwise disqualified to vote.
    II. The applicant shall be required to produce appropriate proof of qualifications as provided in RSA 654:12 and fill out the form as prescribed in paragraph IV.
    III. If an applicant is unable to provide the proof of qualifications as required in RSA 654:12, he or she may register by completing the necessary affidavits, pursuant to RSA 654:12, and completing the form in subparagraph IV(b), unless the person is registering at the polling place on the date of a state general election. If an applicant is registering at the polling place on the date of a state general election and is unable to provide the proof of qualifications as required in RSA 654:12, he or she may register by completing the form in subparagraph IV(c) under oath, which oath may be witnessed by an election official or any other person, working in conjunction with the supervisors of the checklist, who is authorized by law to administer oaths, including, but not limited to, any justice of the peace or notary public; should the applicant not otherwise have proof of identity and therefore be relying upon the form for proof of identity, the act of swearing to the form shall constitute sufficient proof of identity for the purposes of any person administering the oath, notwithstanding any language to the contrary in any laws relating to the administering of oaths for other purposes.
    IV. (a) 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.
       (b) The secretary of state shall prescribe the form of the voter registration form to be used for voter registrations other than those at the polling place on the date of a state general election, 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. 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 ____________________ 
 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 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 am subject to the laws of the state of New Hampshire which apply to all residents, including laws requiring a driver to register a motor vehicle and apply for a New Hampshire's driver's license within 60 days of becoming a resident.
    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 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.
       (c) The secretary of state shall prescribe the form of the voter registration form to be used only for voter registrations at the polling place on the date of a state general election, which shall be in substantially the following form:

 Date ____________________ 
 
 VOTER REGISTRATION FORM 
 FOR USE AT THE POLLING PLACE ON THE DATE OF THE STATE GENERAL ELECTION 
 (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 ____________________ 
 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 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 am subject to the laws of the state of New Hampshire which apply to all residents, including laws requiring a driver to register a motor vehicle and apply for a New Hampshire's driver's license within 60 days of becoming a resident.
    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

If this form is used in place of proof of identity, age, citizenship, or domicile, 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)
 Domicile 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 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. 2012, 285:2, eff. Aug. 26, 2012. 2014, 260:1, eff. July 28, 2014.