N.H. Rev. Stat. § 654:7
___ NEW REGISTRATION I am not registered to vote in New Hampshire
___ TRANSFER I am registered to vote in New Hampshire and have moved my voting domicile to a new town or ward in New Hampshire
___ NAME CHANGE/ADDRESS UPDATE I am registered to vote in this town/ward and have changed my name/address
Date
____________________
VOTER REGISTRATION FORM
(Please print or type)
Last (suffix) First Full Middle Name
Street Ward Number
Town or City Zip Code
Street
Town or City Zip Code
Town or City State
Date
____________________
If a naturalized citizen, give name of court where and date when naturalized
Street Ward Number
I am not currently registered to vote elsewhere (initial here __________), or I request that my name be removed as a registered voter in ______________________________ (fill in your address where previously registered, street, city/town, state, and zip code)
_________________________
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. If a city, ward number __________.
I understand that to vote in this ward/town, I must be at least 18 years of age, I must be a United States citizen, and I must be domiciled in this ward/town.
I understand that a person can claim only one state and one city/town as his or her domicile at a time. I understand that my domicile for voting is that one place from which I participate in democratic self-government and that I have acted to carry out that intent. 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 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 purposely 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.
RSA 654:7
1979, 436:1; 373:1. 1983, 475:1. 1990, 119:1. 1998, 194:2. 2003, 289 : 25 . 2007, 10 : 1 . 2012, 285 : 2 . 2014, 260 : 1 , eff. July 28, 2014. 2016, 185 : 1 , eff. Aug. 2, 2016; 190:1, eff. Aug. 2, 2016. 2017, 205 : 2 , eff. Sept. 8, 2017.