19:59-5 Application form.

5. a. Other than a federal postcard application, an application for a ballot by an overseas voter or overseas federal election voter shall be in substantially the following form:

I, the undersigned, certify the following as a basis for an application as citizen of the United States residing outside the United States to receive a ballot to be voted at the election to be held on ........ (date of election) for .......... (fill in elected office or public question, or both):

1. I am a citizen of the United States;

2. I presently reside at .................... (if mail should be addressed other than to my residence, also provide address for mail);

3. I was born on ..................... (month, day, year)

4. I hold a:

a. valid U.S. Passport # ............, dated .........., or

b. valid U.S. Passport Card # .........., dated .........., or

c. valid Certificate of Citizenship, dated .........., or

d. other valid form of identification recognized as such under federal or state law: .......... (form of identification), dated ...........

5. a. Immediately prior to taking up residence abroad I was domiciled in New Jersey and resided at ............ (street address), .............. (municipality), .............. (county) (If formerly registered to vote from that address check here ( ) ), or

b. I was born outside of the United States and my parent, legal guardian, spouse, partner in civil union, or domestic partner, before leaving the United States, was last domiciled in New Jersey, residing at .......... (street address), .......... (municipality), ..........(county).

6. I am not registered, entitled or applying to vote in any state other than New Jersey.

7. I understand that any false statement knowingly made in this application subjects me to the penalties provided by law for fraudulent voting.

.................... ..................... Applicant

(Signature)

Dated:....................... .........................Applicant

(Print or type name)

b. There shall also be sent to the applicant by air mail or electronic means such instructions and portions of the law or regulations as the Secretary of State shall direct.

c. Any overseas voter or overseas federal election voter requesting that a ballot be sent to that voter by electronic means shall indicate on the application for the ballot the telephone number and location to which the ballot is to be sent or the electronic address of the voter, as may be appropriate.

L.1976, c.23, s.5; amended 1978, c.130, s.2; 1993, c.73, s.7; 2008, c.61, s.5; 2017, c.39, s.4.