INSTRUCTIONS
Mark the (insert "oval" or "square") to the left of the name of your choice. (Provide illustration of correctly-marked voting position here.) To vote for a candidate whose name is not printed on the ballot, (insert "mark the oval (or square) to the left of 'write-in' and print the name clearly" or "print the name clearly in the box labeled 'write-in'"), staying within the box. Any mark or writing outside the spaces provided for voting may void the entire ballot. You have a right to a replacement ballot. If you make a mistake or want to change your vote, call the board of elections at (insert phone number here) for instructions on how to obtain a new ballot. The number of choices is listed for each contest. Do not mark the ballot for more candidates than allowed. If you do, your vote in that contest will not count.
OFFICIAL EARLY MAIL BALLOT
for
GENERAL (OR PRIMARY OR SPECIAL) ELECTION,
..........., 20.......
Name of voter ..................
Residence (street and number if any) ..............
City/or town of (village, if any) .................
County of ...............................
Assembly District ......................
Legislative District (as applicable) ..........
Ward (as applicable) .....................
Election District ....................
Party Enrollment (in case of primary election) ....................
AFFIRMATION
I do declare that I am a citizen of the United States, that I am duly registered in the election district shown on the reverse side of this envelope and I am qualified to vote in such district; that I have not qualified nor do I intend to vote elsewhere, that I have not committed any act nor am I under any impediment which denies me the right to vote.
I hereby declare that the foregoing is a true statement to the best of my knowledge and belief, and I understand that if I make any material false statement in the foregoing statement of early mail voter, I shall be guilty of a misdemeanor.
Date ............... 20 ................ |
.......................... |
Signature or mark of voter |
.......................... |
Signature of Witness |
(required only if voter does not sign their own name) |
.......................... |
Address of Witness |
N.Y. Elec. Law § 7-119