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  
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 
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 
   
 

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_________________________________
  
  
    
 


New York State !bsentee Ballot !pplicaon
Please print clearly; 
This applicaon must either be personally delivered to your county board of elecons not
later than the day before the election, or postmarked by a governmental postal service not
later than 7th day before election day; 



BOARD USE ONLY:
Town/City/Ward/Dist:
Registration No: ____________________
Party: ____________________________
voted in office

I am requesng, in good faith, an absentee ballot due to (check one reason):












   
  

   



 


NY
 

  
 




 

 
 
 



    
!pplicant Must Sign Below
  
 

Sign Here: X_________________________ Date _ _ _ _ / _ _ _ _ / _ _ _ _

 




  




 



Board Use Only
2015 Absentee Ballot Application
MM/DD/YYYY MM/DD/YYYY
MM/DD/YYYY
MM/DD/YYYY
MM/DD/YYYY
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 
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
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
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Instrucons:
Who may apply for an absentee ballot?


Informaon for military and overseas voters:

 
 


Where and when to return your applicaon:
!pplicaons must be mailed seven days before the elecon, or hand-delivered to your county
board of elecons by the day before the elecon; 



Opons available to you if you have an illness or disability:




 

When your ballot will be sent:

 
 
 


 
 

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