2016 New Jersey Revised Statutes
Title 19 - Elections
Section 19:59-5 - Application Form.

19:59-5 Application form.

5. a. An application for an overseas ballot shall be in substantially the following form:

APPLICATION FOR AN OVERSEAS BALLOT

I, the undersigned, certify the following as a basis for an application as citizen of the United States residing outside the United States to receive a ballot to be voted at the election to be held on ......... (date of election) that is to say:

1.I am a citizen of the United States;

2.I presently reside at ....................... (if mail should be addressed other than to my residence, also provide address for mail);

3.I was born on ..................... (month, day, year)

4. a. I hold a valid U.S. Passport # ............, dated .........., or

b.I hold a United States Citizens Identity and Registration Card (Form FS 225) dated ............ issued by .................. (name and location of U.S. Embassy or Consulate).

5.Immediately prior to taking up residence abroad I was domiciled in New Jersey and resided at ............ (street address), .............. (municipality), .............. (county) (If formerly registered to vote from that address check here ( ) ).

6.I do not maintain a domicile in the United States and am not registered, entitled or applying to vote in any state other than New Jersey.

7.I understand that any false statement knowingly made in this application subjects me to the penalties provided by law for fraudulent voting.

......................................... Applicant



(Signature)

Dated:....................... .........................Applicant



(Print or type name)



b.There shall also be sent to the applicant by air mail or electronic means such instructions and portions of the law or regulations as the Secretary of State shall direct.

c.Any overseas voter requesting that a ballot be sent to that voter by electronic means shall indicate on the application for the ballot the telephone number and location to which the ballot is to be sent or the electronic address of the voter, as may be appropriate.

L.1976, c.23, s.5; amended 1978, c.130, s.2; 1993, c.73, s.7; 2008, c.61, s.5.