N.H. Rev. Stat. § 654:17 — NH Code / Title LXIII / Chapter 654 / Section 17
654:17 Absentee Registration Affidavit.
Status: in_force

I. The absentee registration affidavit shall be prepared by the secretary of state and shall be in substantially the following form: Affidavit (Absence from town) I, ____________________ do hereby swear or affirm, under the penalties for voting fraud set forth below, the following: 1) That I am a citizen of the United States, my legal domicile is in the town of ____________________ , New Hampshire, I will be of the age of 18 years or over on election day and am entitled to vote in the election to be held in said town on ____________________ , __________ (date), except for the fact that my name does not appear on the checklist to be used in said town at such election; 2) That I do not intend to be present within said town at such time prior to said election as shall enable me personally to appear before the supervisors of the checklist of said town in their regular sessions for the correction of the checklist for said election; 3) That I am temporarily residing in ____________________ (city and state or city, province, and country); 4) That I hereby enclose copies of the applicable documentation required by RSA 654:12 to establish my citizenship, age, domicile, and identity as qualifications to vote; 5) That I acknowledge that if I do not provide a copy of the documentation as required by section 4) above, this application shall not be approved; and 6) That I hereby make application for the addition of my name to the checklist of said town to be used at said election. _____ Signature of Applicant Date In accordance with RSA 659:34, the penalty for knowingly or purposefully providing false information when registering to vote or voting is a class A misdemeanor with a maximum sentence of imprisonment not to exceed one year and a fine not to exceed $2,000. Fraudulently registering to vote or voting is subject to a civil penalty not to exceed $5,000. Affidavit (Physical Disability) I, ____________________ do hereby swear or affirm, under the penalties for voting fraud set forth below, the following: 1) That I am a citizen of the United States, my legal domicile is in the town of ____________________ , New Hampshire, I will be of the age of 18 years or over on election day, and am entitled to vote in the election to be held in said town on ____________________ , ___ (date), except for the fact that my name does not appear on the checklist to be used in said town at such election; 2) That I am unable by reason of physical disability personally to appear before the supervisors of the checklist of said town in their regular sessions for the correction of the checklist for said election; 3) That I hereby enclose copies of the applicable documentation required by RSA 654:12 to establish my citizenship, age, domicile, and identity as qualifications of vote; 4) That I acknowledge that if I do not provide a copy of the documentation as required by section 3) above, this application shall not be approved; and 5) That I hereby make application for the addition of my name to the checklist of said town to be used at said election. ______________________________ _____ Signature of Applicant _____ Date In accordance with RSA 659:34, the penalty for knowingly or purposefully providing false information when registering to vote or voting is a class A misdemeanor with a maximum sentence of imprisonment not to exceed one year and a fine not to exceed $2,000. Fraudulently registering to vote or voting is subject to a civil penalty not to exceed $5,000. II. There shall be printed below each of the foregoing affidavits the following affirmation: Affirmation I, ____________________ , the undersigned witness, do hereby swear or affirm, under the penalties for voting fraud set forth below, that on the __________ day of __________ , ___ (date), the above named, ____________________ , having satisfied me as to his or her identity, signed the foregoing affidavit in my presence, and did before me swear to (or affirm) the truth of the statements therein contained and the authenticity and accuracy of the documentation submitted therewith. _____ Signature of Witness In accordance with RSA 659:34, the penalty for knowingly or purposefully providing false information when registering to vote or voting is a class A misdemeanor with a maximum sentence of imprisonment not to exceed one year and a fine not to exceed $2,000. Fraudulently registering to vote or voting is subject to a civil penalty not to exceed $5,000.