| Name ____________________________________ | |
| (Print) | |
| Address ______________________________ | |
| _______________________________________ | |
| _______________________________________ | |
| I hereby request that my political party registration be changed as follows: | |
| From: Democrat [ ], or Republican [ ], or (name of any party determined by the secretary of state to have achieved official status under RSA 652:11) [ ] | |
| To: Undeclared [ ] | |
| Signed under the pains and penalties of perjury. | |
| ______________________________________________ | |
| Date ______________ |
Source. 1979, 400:3, 4; 436:1. 1981, 308:3-5. 1987, 129:2. 1993, 193:2-5. 2010, 172:8. 2011, 73:1. 2012, 113:2, 3, eff. May 31, 2012. 2018, 165:1, eff. Aug. 7, 2018.