Article Guide
The New York Absentee Ballot Application form is a crucial tool for voters who may not be able to cast their ballots in person on election day. Designed to be user-friendly, this form requires applicants to provide essential information clearly and accurately. It includes sections for personal identification, such as your name, address, and date of birth, as well as your reason for requesting an absentee ballot, which can range from being out of the county to having a physical disability. Importantly, applicants must submit the form either in person or by mail, with specific deadlines that ensure timely processing. For those with permanent disabilities, the form offers a streamlined option for receiving ballots automatically for future elections. The application also allows for the designation of an agent to pick up the ballot, making the voting process more accessible. Additionally, it emphasizes the importance of honesty, as providing false information can lead to serious legal consequences. Understanding how to fill out this form correctly is essential for ensuring that your voice is heard in the democratic process.
Preview - New York Absentee Ballot Application Form
MM/DD/YYYY
!pplicant Must Sign Below
New York State !bsentee Ballot !pplication
Please print clearly; See detailed instructions/
To receive an absentee ballot:
The ballot itself must either be personally delivered to the board of elections in your county no later than the close of polls on election day, or postmarked by a governmental postal service not later than the day of the election and received no later than 7 days after the election/
BOARD USE ONLY:
Town/City/Ward/Dist:
_________________________________
Registration No: ____________________
Party: ____________________________
voted in office
|
|
|
1/ |
I am requesting, in good faith, an absentee ballot due to (check one reason): |
|
absence from county or New York ity on election day |
|
|
resident or patient of a Veterans Health |
||
|
temporary illness or physical disability |
!dministration Hospital |
|
permanent illness or physical disability |
detention in jail/prison, awaiting trial, awaiting |
|
duties related to primary care of one or more |
|
|
action by a grand jury, or in prison for a conviction |
|
|
individuals who are ill or physically disabled |
|
|
of a crime or offense which was not a felony |
|
|
|
|
|
|
|
2/ |
absentee ballot(s) requested for the following election(s) . |
|
|
Primary Election only |
General Election only |
Special Election only |
!ny election held between these dates. absence begins. _____/_____/_____ |
absence ends. _____/_____/_____ |
MM/DD/YYYY |
MM/DD/YYYY |
3/ |
last name or surname |
|
|
|
|
|
|
first name |
|
|
|
|
middle initial |
|
|
suffix |
|||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4/ |
date of birth MM/DD/YYYY |
|
county where you live |
|
|
|
|
phone number (optional) |
|
email (optional) |
|
|
|
||||||
|
_____ /_____ /_____ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5/ |
address where you live (residence) street |
apt |
|
|
city |
|
|
state |
zip code |
||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
NY |
|
|
|
|||
|
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
|
|
|
|
|
|
|
||||||||||||
6/ |
Delivery of Primary Election allot (check one) |
|
|
Deliver to me in person at the board of elections |
|||||||||||||||
I authorize (give name)._______________________________________ to pick up my ballot at the board of elections/ |
|||||||||||||||||||
|
Mail ballot to me at. (mailing address) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||
|
_______________________________________________________________________________________________________ |
||||||||||||||||||
|
|
street no/ |
street name |
|
|
|
|
apt/ |
city |
|
|
|
state |
|
|
zip code |
|||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
7/ |
Delivery of General (or Special) Election allot (check one) |
Deliver to me in person at the board of elections |
|||||||||||||||||
I authorize (give name)._______________________________________ to pick up my ballot at the board of elections/ |
|||||||||||||||||||
|
Mail ballot to me at. (mailing address) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||
|
________________________________________________________________________________________________________ |
||||||||||||||||||
|
|
street no/ |
street name |
|
|
|
|
apt/ |
city |
|
|
|
state |
|
|
zip code |
|||
8/ |
I certify that I am a qualified and a registered (and for primary, enrolled) voter- and that the information in this application is |
true and correct and that this application will be accepted for all purposes as the equivalent of an affidavit and, if it contains a |
|
|
material false statement, shall subject me to the same penalties as if I had been duly sworn/ |
|
Sign Here: X__________________________ Date ____/____/____ |
If applicant is unable to sign because of illness, physical disability or inability to read, the following statement must be executed. y my mark, duly witnessed hereunder, I hereby state that I am unable to sign my applica- tion for an absentee ballot without assistance because I am unable to write by reason of my illness or physical disability or because I am unable to read/ I have made, or have the assistance in making, my mark in lieu of my signature/ (No power of attorney or preprinted name stamps allowed/ See detailed instructions/)
Date ___/___/___ Name of Voter.____________________________________ Mark.___________________ |
|
MM/DD/YYYY |
|
I, the undersigned, hereby certify that the above named voter affixed his or her mark to this application in my pres- |
|
ence and I know him or her to be the person who affixed his or her mark to said application and understand that |
|
this statement will be accepted for all purposes as the equivalent of an affidavit and if it contains a material false |
|
statement, shall subject me to the same penalties as if I had been duly sworn/ |
|
_____________________________________________ |
______________________________________ |
_____________________________________________ |
(signature of witness to mark) |
(address of witness to mark) |
Board Use Only |
|
|
|
2021 Absentee Ballot Application |
Instructions:
Who may apply for an absentee ballot?
Each person must apply for themselves/ It is a felony to make a false statement in an application for an absentee ballot, to attempt to cast an illegal ballot, or to help anyone to cast an illegal ballot/
Information for military and overseas voters:
If you are applying for an absentee ballot because you or your family are in the military or because you currently reside overseas, do not use this application/ You are entitled to special legal provisions if you apply using the Federal Postcard !pplication (FPCA)/ For more information about military/overseas voting, contact your local board of elections or refer to the Military and Federal Voting sections at. http.//www/elections/ny/gov/Voting/html
Where and when to return your application:
Applications for an absentee ballot that will be delivered
Options available to you if you have an illness or disability:
If you check the box indicating your illness or disability is permanent, once your application is ap- proved you will automatically receive a ballot for each election in which you are eligible to vote, without having to apply again/ You may sign the absentee ballot application yourself, or you may make your mark and have your mark witnessed in the spaces provided on the bottom of the appli- cation/ Please note that a power of attorney or printed name stamp is not allowed for any voting purpose/
When your ballot will be sent:
Your absentee ballot materials will be sent to you beginning 46 days before federal, state, county, city or town elections in which you are eligible to vote/ If you applied after this date, your ballot will be sent immediately after your completed and signed application is received and processed by your local board of elections/ If you provide dates in section 2, identifying the time frame within which you will be absent from your county or from the ity of New York, you will be sent a ballot for any primary, general, special election or presidential primary election which might occur during the time frame you have specified/ If you prefer, you may designate someone to pick up your ballot for you, by completing the required information in section 6 and/or section 7, as appropriate/ ontact your local county board of elections if you have not received your ballot/
Form Characteristics
| Fact Name | Details |
|---|---|
| Application Deadline In-Person | The application must be personally delivered to the county board of elections no later than the day before the election. |
| Application Deadline By Mail | The application must be received by the county board of elections no later than the 15th day before the election. |
| Ballot Submission Deadline | The completed ballot must be either delivered in person by the close of polls on election day or postmarked by election day and received within 7 days after the election. |
| Eligibility to Apply | Any qualified voter may apply for an absentee ballot. A false statement on the application is a felony. |
| Permanent Illness Provision | If a voter indicates a permanent illness, they will automatically receive a ballot for each election without needing to reapply. |
| Witness Requirement | If a voter cannot sign due to illness or disability, they may make a mark that must be witnessed by another person. |
| Military and Overseas Voters | Military and overseas voters must use the Federal Postcard Application (FPCA) instead of this form. |
More PDF Templates
What Does Peo - A form for Professional Employer Organizations (PEOs) in New York seeking either new registration or to renew their existing one.
New York Parenting Plan - Mechanisms for parents to agree upon specific custody arrangements for weekdays and weekends throughout the year.
Ccd1 - Administrative sections are reserved for official use, maintaining the integrity of the review process and ensuring proper documentation.