New York State Voter Registration Form
Register to vote
With this form, you register to vote in elections in
New York State. You can also use this form to:
change the name or address
on your voter registration
become a member of a political party
change your party membership
To register you must:
be a US citizen;
be 18 years old by the end of this year;
not be in prison or on parole
for a felony conviction;
not claim the right to vote elsewhere.
Send or deliver this form
Fill out the form below and send it to your
county’s address on the back of this form,
or take this form to the office of your County
Board of Elections.
Mail or deliver this form at least 25 days before
the election you want to vote in. Your county will
notify you that you are registered to vote.
Questions?
Call your County Board of Elections
listed on the back of this form or
1-800-FOR-VOTE (TDD/ TTY Dial 711)
Find answers or tools on our website
www.elections.ny.gov
Verifying your identity
We’ll try to check your identity before Election
Day, through the DMV number (driver’s license
number or non-driver ID number), or the last
four digits of your social security number,
which you’ll fill in below.
If you do not have a DMV or social security
number, you may use a valid photo ID, a current
utility bill, bank statement, paycheck, government
check or some other government document that
shows your name and address. You may include a
copy of one of those types of ID with this form
be sure to tape the sides of the form closed.
If we are unable to verify your identity before
Election Day, you will be asked for ID when
you vote for therst time.
中文資料:若您有興趣索取中文資料表格,
請電: 1-800-367-8683

1-800-367-8683 
Información en español: si le interesa obtener este
formulario en español, llame al 1-800-367-8683
한국어: 한국어 양식을 원하시면
1-800-367-8683 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.
For board use only
Are you a citizen of the U.S.? Yes No
1
If you answer No, you cannot register to vote.
Qualications
Will you be 18 years of age or
older on or before election day?
Yes No
2
If you answer No, you cannot register to vote unless you will be 18 by the end of the year.
Last name Sufx
Your name
3
First name Middle Initial
Birth date
/ /
4
6
5
7
Sex M F
More information
Items 5, 6 & 7 are optional
Phone
Email
Address (not P.O. box)
Apt. Number Zip code
The address
where you live
8
City/Town/Village
New York State County
Address or P.O. box
The address where
you receive mail
Skip if same as above
P.O. Box Zip code
9
City/Town/Village
Have you voted before? Yes No
11
What year?
Voting history
10
Your name was
Voting information
that has changed
Skip if this has not changed
or you have not voted before
Your address was
12
Your previous state or New York State County was
Identication
You must make 1 selection
For questions, please refer to
Verifying your identity above.
New York State DMV number
13
Last four digits of your Social Security number
xxx xx
I do not have a New York State driver’s license or a Social Security number.
Democratic party
Republican party
Conservative party
Green party
Working Families party
Independence party
Women’s Equality party
Reform party
Other
14
I wish to enroll in a political party
I do not wish to enroll in a political party
No party
Af davit: I swear or afrm that
I am a citizen of the United States.
I will have lived in the county, city or village
for at least 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 $5,000 and/or jailed for up to four years.
Political party
You must make 1 selection
Political party enrollment is
optional but that, in order to
vote in a primary election of
a political party, a voter must
enroll in that political party,
unless state party rules allow
otherwise.
16
Optional questions
15
I need to apply for an Absentee ballot.
I would like to be an Election Day worker.
Sign
Date
Rev. 07/ 2016
Clear Form
Select your New York State County
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
New York City
32 Broadway, 7th Fl.
New York, NY 10004
(212) 487-5300
Albany
32 North Russell Road
Albany, NY 12206
(518) 487-5060
Allegany
6 Schuyler St.
Belmont, NY 14813
(585) 268-9294
Broome
Government Plaza
60 Hawley St.
PO Box 1766
Binghamton, NY
13902
(607) 778-2172
Cattaraugus
207 Rock City St.
Suite 100
Little Valley, NY 14755
(716) 938-2400
Cayuga
157 Genesee St.
(Basement)
Auburn, NY 13021
(315) 253-1285
Chautauqua
7 North Erie St.
Mayville, NY 14757
(716) 753-4580
Chemung
378 South Main St.
PO Box 588
Elmira, NY 14902
(607) 737-5475
Chenango
5 Court St.
Norwich, NY 13815
(607) 337-1760
Clinton
Cnty Government Ctr.
Ste. 104
137 Margaret St.
Plattsburgh, NY 12901
(518) 565-4740
Columbia
401 State St.
Hudson, NY 12534
(518) 828 - 3115
Cortland
112 River St.
Suite 1
Cortland, NY 13045
(607) 753-5032
Delaware
3 Gallant Ave.
Delhi, NY 13753
(607) 832-5321
Dutchess
47 Cannon St.
Poughkeepsie, NY
12601
(845) 486-2473
Erie
134 W. Eagle St.
Buffalo, NY 14202
(716) 858-8891
Essex
7551 Court St.
PO Box 217
Elizabethtown, NY
12932
(518) 873-3474
Franklin
355 West Main St.
Ste. 161
Malone, NY 12953
(518) 481-1663
Fulton
2714 St. Hwy 29
Ste. 1
Johnstown, NY 12095
(518) 736-5526
Genesee
County Building #1
15 Main St.
Batavia, NY 14020
(585) 344-2550
Greene
411 Main St.
Ste. 437
Catskill, NY 12414
(518) 719-3550
Hamilton
Rte. 8
PO Box 175
Lake Pleasant, NY
12108
(518) 548-4684
Herkimer
109 Mary St.
Ste. 1306
Herkimer, NY 13350
(315) 867-1102
Jefferson
175 Arsenal St.
Watertown, NY 13601
(315) 785-3027
Lewis
7660 N. State St.
Lowville, NY 13367
(315) 376-5329
Livingston
County Govt. Ctr.
6 Court St.
Room 104
Geneseo, NY 14454
(585) 243-7090
Madison
County Office Bldg.
N. Court St.
PO Box 666
Wampsville, NY
13163
(315) 366-2231
Monroe
39 Main St. W.
Rochester, NY 14614
(585) 753-1550
Montgomery
Old Courthouse
9 Park St.
PO Box 1500
Fonda, NY 12068
(518) 853-8180
Nassau
240 Old Country Rd.
5th Fl.
Mineola, NY 11501
(516) 571-2411
Niagara
111 Main St.
Ste. 100
Lockport, NY 14094
(716) 438-4040
Oneida
Union Station
321 Main St.
3rd Fl.
Utica, NY 13501
(315) 798-5765
Onondaga
1000 Erie Blvd West
Syracuse, NY 13204
(315) 435-3312
Ontario
74 Ontario St.
Canandaigua, NY
14424
(585) 396-4005
Orange
75 Webster Ave
PO Box 30
Goshen, NY 10924
(845) 360-6500
Orleans
14012 State Rte. 31
Albion, NY 14411
(585) 589-3274
Oswego
185 E. Seneca St.
Box 9
Oswego, NY 13126
(315) 349-8350
Otsego
Ste. 2
140 County Hwy. 33W
Cooperstown, NY
13326
(607) 547-4247
Putnam
25 Old Route 6
Carmel, NY 10512
(845) 808-1300
Rensselaer
Ned Pattison
Government Ctr.
1600 Seventh Ave.
Troy, NY 12180
(518) 270-2990
Rockland
11 New Hempstead Rd.
New City, NY 10956
(845) 638-5172
St. Lawrence
80 State Hwy 310
Canton, NY 13617
(315) 379-2202
Saratoga
50 W. High St.
Ballston Spa, NY
12020
(518) 885-2249
Schenectady
388 Broadway, Ste. E
Schenectady, NY
12305
(518) 377-2469
Schoharie
County Office Bldg.
284 Main St.
PO Box 99
Schoharie, NY 12157
(518) 295-8388
Schuyler
County Office Bldg.
105 9th St., Unit 13
Watkins Glen, NY
14891
(607) 535-8195
Seneca
One DiPronio Dr.
Waterloo, NY 13165
(315) 539-1760
Steuben
3 E. Pulteney Sq.
Bath, NY 14810
(607) 664-2260
Suffolk
Yaphank Ave.
PO Box 700
Yaphank, NY 11980
(631) 852-4500
Sullivan
Govt. Ctr.
100 North St.
PO Box 5012
Monticello, NY 12701
(845) 807-0400
Tioga
1062 State Rte. 38
P.O. Box 306
Owego, NY 13827
(607) 687-8261
Tompkins
Court House Annex
128 E. Buffalo St.
Ithaca, NY 14850
(607) 274-5522
Ulster
284 Wall St.
Kingston, NY 12401
(845) 334-5470
Warren
Cnty. Municipal Ctr.
3rd Floor
Human Serv. Bldg
1340 St. Rte. 9
Lake George, NY
12845
(518) 761-6456
Washington
383 Broadway
Fort Edward, NY
12828
(518) 746-2180
Wayne
7376 State Rte. 31
PO Box 636
Lyons, NY 14489
(315) 946-7400
Westchester
25 Quarropas St.
White Plains, NY
10601
(914) 995-5700
Wyoming
4 Perry Ave.
Warsaw, NY 14569
(585) 786-8931
Yates
Ste. 1124
417 Liberty St.
Penn Yan, NY 14527
(315) 536-5135
(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.
Last name
First name
Middle Initial
Sufx
Address
Apt. Number Zip code
City
By signing below,
you certify that you are:
18 years of age or older;
consenting to donate all of your organs and
tissues for transplantation, research, or both;
authorizing the Board of Elections to provide
your name and identifying information to
DOH for enrollment in the Registry;
and authorizing DOH to allow access to this in-
formation to federally regulated organ procure-
ment organizations and NYS-licensed tissue
and eye banks and hospitals upon your death.
/
Birth date
M M Y YD D
/
Y Y
Sex M F
Eye color Height
Ft. In.
Sign Date