"Voter Registration Form" - New York

Voter Registration Form is a legal document that was released by the New York State Board of Elections - a government authority operating within New York.

Form Details:

  • Released on September 1, 2015;
  • The latest edition currently provided by the New York State Board of Elections;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the New York State Board of Elections.

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Download "Voter Registration Form" - New York

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New York State Voter Registration Form
Register to vote
Send or deliver this form
Verifying your identity
Fill out the form below and send it to your
We’ll try to check your identity before Election
With this form, you register to vote in elections in
county’s address on the back of this form,
Day, through the DMV number (driver’s license
New York State. You can also use this form to:
or take this form to the office of your County
number or non-driver ID number), or the last
Board of Elections.
four digits of your social security number,
• change the name or address
which you’ll fill in below.
on your voter registration
Mail or deliver this form at least 25 days before
• become a member of a political party
the election you want to vote in. Your county will
If you do not have a DMV or social security
notify you that you are registered to vote.
number, you may use a valid photo ID, a current
• change your party membership
utility bill, bank statement, paycheck, government
Questions?
check or some other government document that
To register you must:
shows your name and address. You may include a
Call your County Board of Elections
copy of one of those types of ID with this form—
• be a US citizen;
listed on the back of this form or
be sure to tape the sides of the form closed.
• be 18 years old by the end of this year;
1-800-FOR-VOTE (TDD/TTY Dial 711)
• not be in prison or on parole
If we are unable to verify your identity before
for a felony conviction;
Find answers or tools on our website
Election Day, you will be asked for ID when
www.elections.ny.gov
• not claim the right to vote elsewhere.
you vote for the first time.
Información en español: si le interesa obtener este
যদি আপদি এই ফর্ম টি বাংলাতে পপতে চাি োহতল
中文資料:若您有興趣索取中文資料表格,
한국어: 한국어 양식을 원하시면
請電: 1-800-367-8683
1-800-367-8683
1-800-367-8683
formulario en español, llame al 1-800-367-8683
িম্বতে পফাি করুি
으로 전화 하십시오.
It is a crime to procure a false registration or to furnish false information to the Board of Elections.
Please print in blue or black ink.
Are you a citizen of the U.S.?
Yes
No
For board use only
1
If you answer No, you cannot register to vote.
Qualifications
Will you be 18 years of age or
Yes
No
older on or before election day?
2
If you answer No, you cannot register to vote unless you will be 18 by the end of the year.
Last name
Suffix
Your name
3
First name
Middle Initial
Birth date
Sex
M
F
4
/
/
5
M M
D
D
Y
Y
Y
Y
More information
Items 5, 6 & 7 are optional
Phone
Email
6
7
Address (not P.O. box)
Apt. Number
Zip code
The address
8
where you live
City/Town/Village
New York State County
Address or P.O. box
The address where
you receive mail
P.O. Box
Zip code
9
Skip if same as above
City/Town/Village
Voting history
Have you voted before?
Yes
No
What year?
10
11
Your name was
Voting information
that has changed
Your address was
12
Skip if this has not changed
Your previous state or New York State County was
or you have not voted before
Identification
New York State DMV number
You must make 1 selection
13
x x x – x x –
Last four digits of your Social Security number
For questions, please refer to
I do not have a New York State driver’s license or a Social Security number.
Verifying your identity above.
I wish to enroll in a political party
Affidavit: I swear or affirm that
Political party
Democratic party
• I am a citizen of the United States.
You must make 1 selection
Republican party
• I will have lived in the county, city or village
Conservative party
for at least 30 days before the election.
Political party enrollment is
Green party
• I meet all requirements to register
optional but that, in order to
to vote in New York State.
Working Families party
vote in a primary election of
14
• This is my signature or mark in the box below.
Independence party
a political party, a voter must
• The above information is true, I understand that
Women’s Equality party
enroll in that political party,
16
unless state party rules allow
if it is not true, I can be convicted and fined up
Reform party
otherwise.
to $5,000 and/or jailed for up to four years.
Other
I do not wish to enroll in a political party
Sign
No party
I need to apply for an Absentee ballot.
Optional questions
15
Date
I would like to be an Election Day worker.
New York State Voter Registration Form
Register to vote
Send or deliver this form
Verifying your identity
Fill out the form below and send it to your
We’ll try to check your identity before Election
With this form, you register to vote in elections in
county’s address on the back of this form,
Day, through the DMV number (driver’s license
New York State. You can also use this form to:
or take this form to the office of your County
number or non-driver ID number), or the last
Board of Elections.
four digits of your social security number,
• change the name or address
which you’ll fill in below.
on your voter registration
Mail or deliver this form at least 25 days before
• become a member of a political party
the election you want to vote in. Your county will
If you do not have a DMV or social security
notify you that you are registered to vote.
number, you may use a valid photo ID, a current
• change your party membership
utility bill, bank statement, paycheck, government
Questions?
check or some other government document that
To register you must:
shows your name and address. You may include a
Call your County Board of Elections
copy of one of those types of ID with this form—
• be a US citizen;
listed on the back of this form or
be sure to tape the sides of the form closed.
• be 18 years old by the end of this year;
1-800-FOR-VOTE (TDD/TTY Dial 711)
• not be in prison or on parole
If we are unable to verify your identity before
for a felony conviction;
Find answers or tools on our website
Election Day, you will be asked for ID when
www.elections.ny.gov
• not claim the right to vote elsewhere.
you vote for the first time.
Información en español: si le interesa obtener este
যদি আপদি এই ফর্ম টি বাংলাতে পপতে চাি োহতল
中文資料:若您有興趣索取中文資料表格,
한국어: 한국어 양식을 원하시면
請電: 1-800-367-8683
1-800-367-8683
1-800-367-8683
formulario en español, llame al 1-800-367-8683
িম্বতে পফাি করুি
으로 전화 하십시오.
It is a crime to procure a false registration or to furnish false information to the Board of Elections.
Please print in blue or black ink.
Are you a citizen of the U.S.?
Yes
No
For board use only
1
If you answer No, you cannot register to vote.
Qualifications
Will you be 18 years of age or
Yes
No
older on or before election day?
2
If you answer No, you cannot register to vote unless you will be 18 by the end of the year.
Last name
Suffix
Your name
3
First name
Middle Initial
Birth date
Sex
M
F
4
/
/
5
M M
D
D
Y
Y
Y
Y
More information
Items 5, 6 & 7 are optional
Phone
Email
6
7
Address (not P.O. box)
Apt. Number
Zip code
The address
8
where you live
City/Town/Village
New York State County
Address or P.O. box
The address where
you receive mail
P.O. Box
Zip code
9
Skip if same as above
City/Town/Village
Voting history
Have you voted before?
Yes
No
What year?
10
11
Your name was
Voting information
that has changed
Your address was
12
Skip if this has not changed
Your previous state or New York State County was
or you have not voted before
Identification
New York State DMV number
You must make 1 selection
13
x x x – x x –
Last four digits of your Social Security number
For questions, please refer to
I do not have a New York State driver’s license or a Social Security number.
Verifying your identity above.
I wish to enroll in a political party
Affidavit: I swear or affirm that
Political party
Democratic party
• I am a citizen of the United States.
You must make 1 selection
Republican party
• I will have lived in the county, city or village
Conservative party
for at least 30 days before the election.
Political party enrollment is
Green party
• I meet all requirements to register
optional but that, in order to
to vote in New York State.
Working Families party
vote in a primary election of
14
• This is my signature or mark in the box below.
Independence party
a political party, a voter must
• The above information is true, I understand that
Women’s Equality party
enroll in that political party,
16
unless state party rules allow
if it is not true, I can be convicted and fined up
Reform party
otherwise.
to $5,000 and/or jailed for up to four years.
Other
I do not wish to enroll in a political party
Sign
No party
I need to apply for an Absentee ballot.
Optional questions
15
Date
I would like to be an Election Day worker.
Address and stamp this section
Your address
Place
First-Class
Stamp
Here
Your County Board of Elections address (select from below)
Before mailing,
remove tape,
fold and seal
Schuyler
Chenango
Franklin
Lewis
Oneida
Putnam
Ulster
New York City
County Office Bldg.
5 Court St.
355 West Main St.
7660 N. State St.
Union Station
25 Old Route 6
284 Wall St.
32 Broadway, 7th Fl.
Lowville, NY 13367
321 Main St.
Carmel, NY 10512
105 9th St., Unit 13
Norwich, NY 13815
Ste. 161
Kingston, NY 12401
New York, NY 10004
(607) 337-1760
Malone, NY 12953
(315) 376-5329
3rd Fl.
(845) 808-1300
Watkins Glen, NY
(845) 334-5470
(212) 487-5300
14891
(518) 481-1663
Utica, NY 13501
Clinton
Livingston
Rensselaer
Warren
(607) 535-8195
(315) 798-5765
Albany
Cnty Government Ctr.
Fulton
County Govt. Ctr.
Ned Pattison
Cnty. Municipal Ctr.
6 Court St.
Onondaga
Government Ctr.
Seneca
32 North Russell Road
Ste. 104
2714 St. Hwy 29
3rd Floor
137 Margaret St.
Ste. 1
Room 104
1000 Erie Blvd West
1600 Seventh Ave.
One DiPronio Dr.
Human Serv. Bldg
Albany, NY 12206
Waterloo, NY 13165
(518) 487-5060
Plattsburgh, NY 12901
Johnstown, NY 12095
Geneseo, NY 14454
Syracuse, NY 13204
Troy, NY 12180
1340 St. Rte. 9
(315) 539-1760
(518) 565-4740
(518) 736-5526
(585) 243-7090
(315) 435-3312
(518) 270-2990
Lake George, NY
Allegany
12845
Columbia
Genesee
Madison
Ontario
Rockland
Steuben
6 Schuyler St.
(518) 761-6456
401 State St.
County Building #1
County Office Bldg.
74 Ontario St.
11 New Hempstead Rd.
3 E. Pulteney Sq.
Belmont, NY 14813
Bath, NY 14810
(585) 268-9294
Hudson, NY 12534
15 Main St.
N. Court St.
Canandaigua, NY
New City, NY 10956
Washington
(607) 664-2260
(518) 828-3115
Batavia, NY 14021
PO Box 666
14424
(845) 638-5172
383 Broadway
Broome
Wampsville, NY
(585) 396-4005
(585) 344-2550
Fort Edward, NY
Cortland
St. Lawrence
Suffolk
Government Plaza
13163
12828
112 River St.
Greene
Orange
48 Court St.
Yaphank Ave.
60 Hawley St.
(315) 366-2231
(518) 746-2180
PO Box 1766
Suite 1
411 Main St.
75 Webster Ave
Canton, NY 13617
PO Box 700
Monroe
Binghamton, NY
Cortland, NY 13045
Ste. 437
PO Box 30
(315) 379-2202
Yaphank, NY 11980
Wayne
Catskill, NY 12414
39 Main St. W.
Goshen, NY 10924
(631) 852-4500
13902
(607) 753-5032
7376 State Rte. 31
Saratoga
(518) 719-3550
Rochester, NY 14614
(845) 360-6500
PO Box 636
(607) 778-2172
Delaware
50 W. High St.
Sullivan
(585) 753-1550
Lyons, NY 14489
Cattaraugus
3 Gallant Ave.
Hamilton
Orleans
Ballston Spa, NY
Gov’t. Ctr.
(315) 946-7400
Montgomery
12020
207 Rock City St.
Delhi, NY 13753
Rte. 8
14012 State Rte. 31
100 North St.
PO Box 175
Old Courthouse
Albion, NY 14411
(518) 885-2249
PO Box 5012
Westchester
Suite 100
(607) 746-2315
Lake Pleasant, NY
9 Park St.
(585) 589-3274
Monticello, NY 12701
25 Quarropas St.
Little Valley, NY 14755
Dutchess
Schenectady
(716) 938-2400
12108
PO Box 1500
(845) 807-0400
White Plains, NY
47 Cannon St.
Oswego
388 Broadway, Ste. E
(518) 548-4684
Fonda, NY 12068
10601
Schenectady, NY
Tioga
Cayuga
Poughkeepsie, NY
185 E. Seneca St.
(518) 853-8180
(914) 995-5700
Herkimer
Box 9
12305
1062 State Rte. 38
157 Genesee St.
12601
(845) 486-2473
109 Mary St.
Nassau
Oswego, NY 13126
(518) 377-2469
P.O. Box 306
Wyoming
(Basement)
Auburn, NY 13021
Ste. 1306
240 Old Country Rd.
(315) 349-8350
Owego, NY 13827
4 Perry Ave.
Erie
Schoharie
(315) 253-1285
Herkimer, NY 13350
5th Fl.
(607) 687-8261
Warsaw, NY 14569
Otsego
134 W. Eagle St.
County Office Bldg.
Mineola, NY 11501
(315) 867-1102
(585) 786-8931
Ste. 2
284 Main St.
Tompkins
Chautauqua
Buffalo, NY 14202
(516) 571-2411
(716) 858-8891
Jefferson
140 County Hwy. 33W
PO Box 99
Court House Annex
Yates
7 North Erie St.
Mayville, NY 14757
175 Arsenal St.
Niagara
Cooperstown, NY
Schoharie, NY 12157
128 E. Buffalo St.
Ste. 1124
Essex
(716) 753-4580
Watertown, NY 13601
111 Main St.
13326
(518) 295-8388
Ithaca, NY 14850
417 Liberty St.
7551 Court St.
Ste. 100
(607) 547-4247
(607) 274-5522
(315) 785-3027
Penn Yan, NY 14527
Chemung
PO Box 217
Lockport, NY 14094
(315) 536-5135
Elizabethtown, NY
378 South Main St.
(716) 438-4040
PO Box 588
12932
Elmira, NY 14902
(518) 873-3474
(607) 737-5475
(Optional) Register to donate your organs and tissues
If you would like to be an organ and tissue donor, you may enroll in
You will receive a confirmation letter from DOH, which will also
the NYS Department of Health (DOH) Donate Life™ Registry online
provide you an opportunity to limit your donation.
at www.nyhealth.gov or provide your name and address below.
By signing below,
Last name
you certify that you are:
First name
• 18 years of age or older;
• consenting to donate all of your organs and
Middle Initial
Suffix
tissues for transplantation, research, or both;
• authorizing the Board of Elections to provide
Address
your name and identifying information to
DOH for enrollment in the Registry;
Apt. Number
Apt. Number
Zip code
• and authorizing DOH to allow access to this in-
formation to federally regulated organ procure-
City
ment organizations and NYS-licensed tissue
and eye banks and hospitals upon your death.
Birth date
Sex
M
F
/
/
M
M
D
D
Y
Y
Y
Y
Eye color
Height
Ft.
In.
Sign
Date
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