HB 535 - AS INTRODUCED
2021 SESSION
21-0722
11/04
HOUSE BILL 535
AN ACT relative to the qualified voter affidavit.
SPONSORS: Rep. Berry, Hills. 44
COMMITTEE: Election Law
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ANALYSIS
This bill repeals the qualified voter affidavit and sworn statements on registration forms for use
in election day voter registration.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
 HB 535 - AS INTRODUCED
21-0722
11/04
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty One
AN ACT relative to the qualified voter affidavit.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 1 Voter Registration; Form. Amend RSA 654:7, IV(c) to read as follows:
2 (c) The secretary of state shall prescribe the form of the voter registration form to be
3 used only for voter registrations, transfers, or updates starting 30 days before each election and at
4 the polling place on election day, which shall be in substantially the following form:
5 ___ NEW REGISTRATION I am not registered to vote in New Hampshire
6 ___ TRANSFER I am registered to vote in New Hampshire and have moved my voting domicile to a
7 new town or ward in New Hampshire
8 ___ NAME CHANGE/ADDRESS UPDATE I am registered to vote in this town/ward and have
9 changed my name/address
10 Date registration form is submitted _______________
11 Date applicant moved to the address listed below as the voter's domicile __________
12 VOTER REGISTRATION FORM
13 FOR USE STARTING 30 DAYS BEFORE AN ELECTION AND AT THE POLLING PLACE ON
14 ELECTION DAY
15 (Please print or type)
16 1. Name ____________________________________________________________
17 Last (suffix) First Full Middle Name
18 2. Domicile Address __________________________________________________
19 Street Ward Number
20 _____________________________________________________________________
21 Town or City Zip Code
22 3. Mailing Address if different than in 2 ________________________________
23 Street
24 _____________________________________________________________________
25 Town or City Zip Code
26 4. Place and Date of Birth ____________________________________________
27 Town or City State
28 Date____________________
29 5. Are you a citizen of the United States? Yes _____ No _____
30 If a naturalized citizen, give name of court where and date when naturalized
31 _____________________________________________________________________
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1 6. Place last registered to vote _________________________________________
2 Street Ward Number
3 I am not currently registered to vote elsewhere (initial here __________), or I request that my name
4 be removed as a registered voter in ______________________________ (fill in your address where
5 previously registered, street, city/town, state, and zip code)
6 7. Name under which previously registered, if different from above
7 _____________________________________________________________________
8 8. Party Affiliation (if any) _____________________________________________
9 9. Driver's License Number _________________________State ______________
10 If you do not have a valid driver's license, provide the last four digits of your social security
11 number __________
12 My name is ____________________. I am today registering to vote in the city/town of
13 ____________________, New Hampshire. If a city, ward number __________.
14 I understand that to vote in this ward/town, I must be at least 18 years of age, I must be a
15 United States citizen, and I must be domiciled in this ward/town.
16 I understand that a person can claim only one state and one city/town as his or her domicile at a
17 time. A domicile is that place, to which upon temporary absence, a person has the intention of
18 returning. By registering or voting today, I am acknowledging that I am not domiciled or voting in
19 any other state or any other city/town.
20 In declaring New Hampshire as my domicile, I realize that I am not qualified to vote in the state
21 or federal elections in another state.
22 If I have any questions as to whether I am entitled to vote in this city/town, I am aware that a
23 supervisor of the checklist is available to address my questions or concerns.
24 I understand that to make the address I have entered above my domicile for voting I must have
25 an intent to make this the one place from which I participate in democratic self-government and
26 must have acted to carry out that intent.
27 [I understand that if I have documentary evidence of my intent to be domiciled at this address
28 when registering to vote, I must either present it at the time of registration or I must place my
29 initials next to the following paragraph and mail a copy or present the document at the town or city
30 clerk's office within 10 days following the election (30 days in towns where the clerk's office is open
31 fewer than 20 hours weekly).
32 _____ By placing my initials next to this paragraph, I am acknowledging that I have not
33 presented evidence of actions carrying out my intent to be domiciled at this address, that I
34 understand that I must mail or personally present to the clerk's office evidence of actions carrying
35 out my intent within 10 days following the election (or 30 days in towns where the clerk's office is
36 open fewer than 20 hours weekly), and that I have received the document produced by the secretary
 HB 535 - AS INTRODUCED
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1 of state that describes the items that may be used as evidence of a verifiable action that establishes
2 domicile.
3 Failing to report and provide evidence of a verifiable action will prompt official mail to be sent to
4 your domicile address by the secretary of state to verify the validity of your claim to a voting domicile
5 at this address.
6 I understand that if I do not have any documentary evidence of my intent to be domiciled at this
7 address, I must place my initials next to the following paragraph:
8 _____ By placing my initials next to this paragraph, I am acknowledging that I am aware of no
9 documentary evidence of actions carrying out my intent to be domiciled at this address, that I will
10 not be mailing or delivering evidence to the clerk's office, and that I understand that officials will be
11 sending mail to the address on this form or taking other actions to verify my domicile at this
12 address.]
13 I acknowledge that I have read and understand the above qualifications for voting and do hereby
14 swear, under the penalties for voting fraud set forth below, that I am qualified to vote in the above-
15 stated city/town, and, if registering on election day, that I have not voted and will not vote at any
16 other polling place this election.
17 __________________ _________________________________________
18 Date Signature of Applicant
19 [If this form is used in place of proof of identity, age, or citizenship, I hereby swear that such
20 information is true and accurate to the best of my knowledge.
21 This form was executed for purposes of proving (applicant shall circle yes or no and initial each
22 item):
23 Identity yes/no _____
24 (initials)
25 Citizenship yes/no _____
26 (initials)
27 Age yes/no _____
28 (initials)
29 _________________________ _______________________________
30 Applicant Election Official
31 _________________________
32 Notary Public/Justice of the Peace/Official Authorized by RSA 659:30]
33 In accordance with RSA 659:34, the penalty for knowingly or purposely providing false
34 information when registering to vote or voting is a class A misdemeanor with a maximum sentence
35 of imprisonment not to exceed one year and a fine not to exceed $2,000. Fraudulently registering to
36 vote or voting is subject to a civil penalty not to exceed $5,000. In accordance with RSA 659:34-a
 HB 535 - AS INTRODUCED
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1 voting in more than one state in the same election is a class B felony with a maximum sentence of
2 imprisonment not to exceed 7 years and a fine not to exceed $4,000.
3 [V. The secretary of state shall prepare and distribute an addendum to the voter registration
4 form used under subparagraph IV(c) to be distributed to those registrants who register within 30
5 days before the election or on election day and who do not provide proof of domicile or a verifiable
6 action to demonstrate domicile. The "verifiable action of domicile" document shall provide notice of
7 the requirements that registrants must furnish documentary evidence of domicile and shall be in
8 substantially the following form:
9 Verifiable Action of Domicile
10 As a newly registered voter, you have received this document because you did not provide proof
11 of domicile when you registered to vote. RSA 654:2, IV requires you to provide evidence that you
12 have taken a verifiable act to establish domicile.
13 The following checklist shall be used as a guide for what you may use as evidence and shall be
14 submitted to the town or city clerk along with documentation that you are required to provide. Only
15 one item on the list is required to demonstrate a verifiable act.
16 To establish that you have engaged in a verifiable act establishing domicile, provide evidence
17 that you have done at least one of the following:
18 ___ established residency, as set forth in RSA 654:1, I-a, at an institution of learning at the
19 address on the voter registration form
20 ___ rented or leased an abode, for a period of more than 30 days, to include time directly prior to
21 an election day at the address listed on the voter registration form
22 ___ purchased an abode at the address listed on the voter registration form
23 ___ obtained a New Hampshire resident motor vehicle registration, driver's license, or
24 identification card issued under RSA 260:21, RSA 260:21-a, or RSA 260:21-b listing the address on
25 the voter registration form
26 ___ enrolled a dependent minor child in a publicly funded elementary or secondary school which
27 serves the town or ward of the address where the registrant resides, as listed on the voter
28 registration form
29 Identified the address on the voter registration form as your physical residence address on:
30 ___ state or federal tax forms
31 ___ other government-issued forms or identification. Describe form of identification:
32 _______________
33 ___ provided the address on the voter registration form to the United States Post Office as your
34 permanent address, provided it is not a postal service or commercial post office box, where mail is
35 delivered to your home. This can be by listing the address on the voter registration form as your new
36 address on a Postal Service permanent change of address form and providing a copy of the receipt, or
37 an online emailed receipt
 HB 535 - AS INTRODUCED
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1 ___ obtained public utility services (electricity, cable, gas, water, etc.) for an indefinite period at
2 the address on the voter registration form. List services obtained: _________________________
3 ___ arranged for a homeless shelter or similar service provider to receive United States mail on
4 your behalf. Enter name of the shelter or provider: _________________________
5 ___ describe what other verifiable action or actions you have taken to make the address listed on
6 your voter registration form your one voting domicile: _________________________
7 If you have no other proof of a verifiable act establishing domicile, and your domicile is at an
8 abode rented, leased, or purchased by another and your name is not listed on the rental agreement,
9 lease, or deed, you are required to provide a written statement, signed under penalty of voting fraud
10 if false information is provided, from a person who is listed on such document, or other reasonable
11 proof of ownership or control of the property, attesting that you reside at that address, signed by
12 that person or his or her agent who manages the property.
13 This verifiable action of domicile form, along with your written statement or other
14 documentation proving a verifiable act, shall be delivered to the town or city clerk, by mail or in
15 person, with 10 days, or within 30 days if the clerk's office is open fewer than 20 hours weekly.
16 Name ________________________________________________________________
17 Last (suffix) First Full Middle Name
18 Domicile Address ______________________________________________________
19 Street Ward Number
20 ______________________________________________________________________
21 Town or City Zip Code
22 __________________ __________________________________________
23 Date Signature of Applicant
24 This document was received by the clerk, who examined and returned it to the applicant after
25 making a copy of the evidence of verifiable action, said copy to be attached to the verifiable action of
26 domicile form.
27 _________________ ________________________________________________
28 Date Signature of Clerk
29 The clerk shall forward the completed form and attachment or attachments to the supervisors of
30 the checklist as soon as possible, but not later than their next meeting. The supervisors of the
31 checklist shall attach the form and attachments to the voter registration form.]
32 2 General Voter Registration; Determining Qualifications of Applicant; Qualified Voter
33 Affidavit. Amend RSA 654:12, I(a) and (b) to read as follows:
34 I. When determining the qualifications of an applicant, the supervisors of the checklist, or
35 the town or city clerk, shall require the applicant to present proof of citizenship, age, and domicile,
36 as provided in the following categories:
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1 (a) CITIZENSHIP. The supervisors of the checklist, or the town or city clerk, shall
2 accept from the applicant any one of the following as proof of citizenship: the applicant's birth
3 certificate, passport, naturalization papers if the applicant is a naturalized citizen, [a qualified voter
4 affidavit, a sworn statement on the voter registration form used starting 30 days before an election
5 and on election day,] or any other reasonable documentation which indicates the applicant is a
6 United States citizen. [The qualified voter affidavit shall be in the following form, and shall be
7 retained in accordance with RSA 33-A:3-a:
8 Date: ____________________
9 QUALIFIED VOTER AFFIDAVIT (Identity, Citizenship, Age)
10 Name: ______________________________
11 Name at birth if different: ______________________________
12 Place of birth: ______________________________
13 Date of birth: ____________________
14 Date and Place of Naturalization: ______________________________
15 Domicile Address: ________________________________________
16 Mailing Address (if different): ________________________________________
17 Telephone number (requested but optional) ____________________
18 Email address (requested but optional) ____________________
19 I hereby swear and affirm, under the penalties for voting fraud set forth below, that I am not in
20 possession of some or all of the documents necessary to prove my identity, citizenship, and age and
21 that I am the identical person whom I represent myself to be, that I am a duly qualified voter of this
22 town (or ward), that I am a United States citizen, that I am at least 18 years of age as of this date or
23 will be at the next election, and that to the best of my knowledge and belief the information above is
24 true and correct.
25 _________