Fillable Village of Farmingdale !bsentee Ballot !pplication (Village of Farmingdale)

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Village of Farmingdale !bsentee Ballot !pplication (Village of Farmingdale)

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Village of Farmingdale !bsentee Ballot !pplication

Inc. Village of Farmingdale

361 Main Street, Farmingdale, NY 11735

(516)249-0093

Please print clearly; See detailed instructions on back.

This application must either be personally delivered to the Village Clerk not later than the day before the election, or

postmarked by a governmental postal service not later than 7th day before election day; be

received by the Village Clerk .



I am requesng, in good faith, an absentee ballot due to (check one reason):





 



















   

  



   







 





   



     

 













 

 

 







     

!pplicant Must Sign Below

  

 



Sign Here: X__________________________ Date ____/____/____



 









 









 







Board Use Only

2015 Absentee Ballot Application

MM/DD/YYYY MM/DD/YYYY

MM/DD/YYYY

Instrucons:

Who may apply for an absentee ballot?

Each person must apply for themselves/ It is a felony to make a false statement in an applicaon

for an absentee ballot, to aempt to cast an illegal ballot, or to help anyone to cast an illegal ballot/

Where and when to return your application:

Applications must be mailed seven days before the election, or hand-delivered to your Village Clerk

by the day before the election. Mailing address is:

Village Clerk

Village of Farmingdale

361 Main Street

Farmingdale, NY 11735

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

approved, 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

application. 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 at least 6 days before the election in which you

are eligible to vote. If applicant or agent delivers the application to the Village Clerk in person after

the seventh day before the village election and not later than the day before the election, the

Village Clerk shall deliver such absentee ballots for those applicants or their agents named in the

application when such applicants or agents appear in the Village Clerk’s office.

Fillable Village of Farmingdale !bsentee Ballot !pplication (Village of Farmingdale)

Fill Online, Printable, Fillable, Blank Village of Farmingdale !bsentee Ballot !pplication (Village of Farmingdale) Form

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