New Jersey § 19:31-6

§ 19:31-6.

a. The Secretary of State shall cause to be prepared and shall provide to each county

commissioner of registration forms of size and weight suitable for mailing, which

shall require the information required by R.S.19:31-3 in substantially the following form: VOTER REGISTRATION APPLICATION Print clearly in ink. Use ballpoint pen or marker. (1) This form is being used as: [ ] New registration [ ] Address change [ ] Name change (2) Name: ․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․ Last First Middle (3) Are you a citizen of the United States of America? Yes No (4) Will you be 18 years of age on or before election day? Yes No If you checked 'No' in response to either of these questions, do not complete this

form. (5) Street Address where you live: ․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․ Street Address Apt. No. ․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․ (6) City or Town County Zip Code (7) Address Where You Receive Your Mail (if different from above): ............................................................ (8) Date of Birth: ․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․ Month Day Year (9)(a) Telephone Number (optional)...................... (b) E-Mail Address (optional)..................... (10) Name and address of Your Last Voter Registration ............................................................ ............................................................ ............................................................ (11) If you are registering by mail to vote and will be voting for the first time

in your current county of residence, please provide one of the following: (a) your New Jersey driver's license number: ................................ (b) the last four digits of your Social Security Number.................... OR submit with this form a copy of any one of the following documents: a current

and valid photo identification card; a current utility bill, bank statement, government

check, pay check or any other government or other identifying document that shows

your name and current address. If you do not provide either your New Jersey driver's license number or the last

four digits of your Social Security Number, or enclose a copy of one of the documents

listed above, you will be asked for identification when voting for the first time,

unless you are exempt from doing so under federal or State law. (12) Do you wish to declare a political party affiliation? (Optional): YES. Name of Party: NO. I do not wish to declare a political party affiliation at this time. (13) I wish to receive a Mail-in Ballot for all future elections, until I request

otherwise in writing. (14) Declaration--I swear or affirm that: I am a U.S. citizen. I live at the above address. I will be at least 18 years old on or before the day of the next election. I am not serving a sentence of incarceration due to a conviction for an indictable offense under any federal or State laws. I UNDERSTAND THAT ANY FALSE OR FRAUDULENT REGISTRATION MAY SUBJECT ME TO A FINE OF

UP TO $15,000, IMPRISONMENT UP TO FIVE YEARS, OR BOTH PURSUANT TO R.S.19:34-1 . ․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․ Signature or mark of the registrant Date (15) If applicant is unable to complete this form, print the name and address of individual

who completed this form. ․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․ Name ․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․ Address In addition, the form may include notice to the applicant of information and options

relating to the registration and voting process, including but not limited to notice

of qualifications required of a registered voter; notice of the final day by which

a person must be registered to be eligible to vote in an election; notice of the

effect of a failure to provide required identification information; a place at which

the applicant may indicate availability for service as a member of the district board

of elections; a place at which the applicant may indicate whether he or she requires

a polling place which is accessible to individuals with disabilities and the elderly

or whether he or she is legally blind; a place at which the applicant may indicate

a desire to receive additional information concerning voting by mail; and if the

application indicates a political party affiliation, the voter is permitted to vote

in the primary election of a political party other than the political party in which

the voter was affiliated previously only if the voter registration form with the change

of political party affiliation is filed prior to the 50th day next preceding the primary

election. The form may also include a space for the voter registration agency to record whether

the applicant registered in person, by mail or by other means. b. The reverse side of the registration form shall bear the address of the Secretary

of State or the commissioner of registration to whom such form is supplied, and a

United States postal permit the charges upon which shall be paid by the State. c. The Secretary of State shall cause to be prepared registration forms of the size,

weight and form described in subsection a. of this section in both the English and

Spanish language and shall provide such forms to each commissioner of registration

of any county in which there is at least one election district in which bilingual

sample ballots must be provided pursuant to R.S.19:14-21 , R.S.19:49-4 or section 2 of P.L.1965, c. 29 ( C.19:23-22.4 ). d. The commissioner of registration shall furnish such registration forms upon request

in person to any person or organization in such reasonable quantities as such person

or organization shall request. The commissioner shall furnish no fewer than two such forms to any person upon request

by mail or by telephone. e. Each such registration form shall have annexed thereto instructions specifying

the manner and method of registration, and the vote by mail option specified on the

form, and stating the qualifications for an eligible voter. f. The Secretary of State shall also furnish such registration forms and such instructions

to the Director of the Division of Workers' Compensation, the Director of the Division

of Employment Services, and the Director of the Division of Unemployment and Temporary

Disability Insurance in the Department of Labor and Workforce Development; to the

Director of the Division of Taxation in the Department of the Treasury; to the Executive

Director of the New Jersey Transit Corporation; to the appropriate administrative

officer of any other public agency, as defined by subsection a. of section 15 of P.L.1974,

c. 30 ( C.19:31-6.3 ); to the Adjutant General of the Department of Military and Veterans' Affairs;

and to the chief administrative officer of any voter registration agency, as defined

in subsection a. of section 26 of P.L.1994, c. 182 ( C.19:31-6.11 ). g. All registration forms received by the Secretary of State in the mail or forwarded

to the Secretary of State shall be forwarded to the commissioner of registration in

the county of the registrant. Each such form, and any registration form received otherwise by a commissioner of

registration, shall be forwarded to the county clerk if the vote by mail option is

selected on a form. h. An application to register to vote received from the New Jersey Motor Vehicle Commission

or a voter registration agency, as defined in subsection a. of section 26 of P.L.1994, c. 182 ( C.19:31-6.11 ), shall be deemed to have been timely made for the purpose of qualifying an eligible

applicant as registered to vote in an election if the date on which the commission

or agency shall have received that document in completed form, as indicated in the

lower right hand corner of the form, was not later than the 21st day preceding that

election. i. Each commissioner of registration shall make note in the permanent registration

file of each voter who is required to provide the personal identification information

required pursuant to this section, as amended, and R.S.19:15-17 , R.S.19:31-5 and Pub.L.107-252 ( 42 U.S.C.s. 15301 et seq. ), to indicate the type of identification provided by the voter and the date on which

it is provided. Prior to the June 2004 primary election, when such a newly registered voter seeks

to vote for the first time following his or her registration, the voter will be required

to provide such personal identification information. Beginning with the June 2004 primary election, when such a newly registered voter

seeks to vote for the first time following his or her registration, the voter will

not be required to provide such information if he or she had previously provided the

personal identification information required pursuant to this section. The required information shall be collected and stored for the time and in the manner

required pursuant to regulations promulgated by the Secretary of State. j. The Secretary of State shall amend the voter registration application form if necessary

to conform to the requirements of applicable federal or State law. k. In the event that the name of any political party entered on the voter registration

form by a voter who wishes to declare a political party affiliation is not legible,

the commissioner of registration shall mail the voter a political party declaration

form and a letter explaining that the voter's choice was not understood and that the

voter should complete and return the declaration form in order to be affiliated with

a party.