This form must contain original signature(s) in ink and be notarized or subscribed to.
Copies of signatures, including those on faxes, PDFs, or other electronic files, are not acceptable.
A candidate or c
ommittee must file this form with the New York State Board of Elections (NYSBOE) at the address at the bottom of this
page, unless in a village where the village clerk runs the election.
For State Campaign: Check this box for candidates or committees supporting or opposing candidates for New York State Governor,
Lt. Governor, State Comptroller, State Attorney General, State Senate, State Assembly, State Supreme Court and certain party offices,
as well as those solely supporting or opposing statewide ballot propositions. These committees must file this form and the required
financial disclosure reports with the NYSBOE.
For Local Campaign: Check this box for all other offices and local ballot propositions, and list the county name where the local office
is being sought or the ballot proposition is appearing. Candidates or committees supporting or opposing such candidates or ballot
propositions must file this form and the required financial disclosure reports with the NYSBOE (or Village Clerk only in the situation
where the Village Clerk runs the election).
Candidate or Committee: Check the appropriate box to indicate whether this is a candidate or a committee seeking a claim of
Item A: Candidates for statewide office must provide the office sought, district number (if applicable) and election year. Local
candidates must provide the office sought, including the name and type of municipality (e.g., City of Newburgh; Town of Colonie; Village
of Scotia). The district and election year must also be provided.
Item B: Enter the name of the candidate or committee. Enter the treasurer's full name, if applicable. Residential address is mandatory,
include building and apartment number (if applicable). P.O. Box is not allowed for residential address. A mailing address must
be included if different than the residential address. Email address is also mandatory. Please note: the email address will be used as a
log-in for the filing system (if exemption status changes) and by the NYSBOE to communicate with its filers. The email address should
be one that the candidate/treasurer accesses regularly and must be updated with the NYSBOE immediately if a change is made. Multi-
factor authentication will be used.
Item C: Candidates who do not receive or spend more than $50 (this threshold includes a candidate's own personal funds), including
candidates for county committee of a political party or for delegate or alternate delegate to a judicial district convention, must inform the
NYSBOE in writing of this fact.
Item D: A committee formed solely to support or oppose a ballot issue, that does not raise or spend over $100, is not required to file
campaign financial disclosure reports.
Item E: Candidates and authorized committees solely supporting one candidate for public office, or solely supporting or opposing a
ballot proposition, in towns, cities or villages having a population under 10,000, where the candidate and/or committee does not raise or
spend in excess of $1,000 in the aggregate for the campaign, are not required to file campaign financial disclosure reports. This
threshold includes the personal funds of the candidate.
Note: This exemption may become invalid, requiring registration and filing of campaign financial disclosure reports with the NYSBOE,
if the candidate or committee supports or opposes candidates or ballot propositions outside of the applicable jurisdiction.
Note: For a town or village, ballot propositions not submitted to the voters of that municipality at the time of a general election fall
outside the scope of NYS Election Law. Therefore, committees solely supporting ballot propositions in a town or village taking place
other than in November do not have to make campaign financial disclosures relative to their ballot proposition activity. In this instance,
this form does not have to be filed.
Once completed, this form - with original signature(s) in ink - must be mailed to: NYS Board of Elections
Attn: Compliance Unit
40 North Pearl Street, Suite 5
Albany, NY 12207
CF-05 Claim of Exemption (01/20)