Are you a citizen of U.S.? If you answer No, you cannot register to vote.

Will you be 18 years of age or older on or before election day? If you answer No, you cannot register to vote unless you will be 18 by the end of the year.

Your name

More information Sex

Address where you live(not P.O. box)

Address where you receive mail

Have you voted before?

Voting information that has changed

Identification (You must take one selection)
New York State DMV number Last four digits of your Social Security number I do not have a New York State driver's license or a Social Security number

I wish to enroll in a political party Democratic party Republican party Conservative party Green party Working Families party Independence party Woman's Equality party Reform party Other I do not wish to enroll in a political party

Optional questions I need to apply for an Absentee ballot I wood like to be an Election Day worker

Affidavit: I swear or affirm that

• I am a citizen of the United States.
• I will have lived in the county, city or village for at list 30 days before the election.
• I meet all requirements to register to vote in New York State.
• This is my signature or mark in the box below.
• The above information is true, I understand that if it is not true, I can be convicted and fined up to $5000 and/or jailed for up to four years.