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The New York Absentee Ballot Application form serves as a crucial tool for voters who cannot physically attend the polls on election day. This form allows individuals to request an absentee ballot for various reasons, such as being out of the county, having a temporary or permanent illness, or fulfilling caregiving duties. Applicants must provide personal information, including their name, date of birth, and address, and indicate their preferred method of ballot delivery—either in person or by mail. It's essential to submit the application on time; for in-person requests, it must be delivered to the county board of elections by the day before the election, while mail applications need to be received 15 days prior. The form also includes sections for voters to certify their eligibility and confirm that the information provided is accurate. In cases where an applicant cannot sign due to a disability, provisions are in place for a witness to assist with the application process. Understanding the details and requirements of this form is vital for ensuring that every eligible voter can participate in the democratic process, even when they are unable to vote in person.

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MM/DD/YYYY
!pplicant Must Sign Below

New York State !bsentee Ballot !pplication

Please print clearly; See detailed instructions/

To receive an absentee ballot: In-Person - Application must be personally delivered to your county board of elections not later than the day before the election. By Mail - Application must be received by your county board of elections not later than the 15th day before the election.

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

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last name or surname

 

 

 

 

 

 

first name

 

 

 

 

middle initial

 

 

suffix

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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date of birth MM/DD/YYYY

 

county where you live

 

 

 

 

phone number (optional)

 

email (optional)

 

 

 

 

_____ /_____ /_____

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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address where you live (residence) street

apt

 

 

city

 

 

state

zip code

 

 

 

 

 

 

 

 

 

 

 

 

 

NY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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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

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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 in-person at the county board of elections to the voter or an agent of the voter must be received not later than the day before the election. Applications for a ballot to be delivered by mail to the voter must be received at the county board of elections no later than 15 days before the election. If the address of your county board of elections is not provided on this form, contact information for your local election office can be found on the New York State oard of Elections’ website, under “ounty oards of Election” directory at. http.//www/elections/ny/gov/ountyoards/html

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 Specifications

Fact Name Description
Application Deadline (In-Person) The absentee ballot application must be personally delivered to your county board of elections no later than the day before the election.
Application Deadline (By Mail) For mail applications, the request must be received by your county board of elections no later than 15 days before the election.
Ballot Submission Deadline The completed ballot must be either personally delivered to the board of elections by the close of polls on election day or postmarked by election day and received within 7 days after the election.
Eligibility to Apply Every voter must apply for themselves; making a false statement on the application is a felony.
Reasons for Absence Applicants can request an absentee ballot for various reasons, including absence from the county, illness, or detention.
Permanent Illness Provision If an applicant has a permanent illness, they will automatically receive a ballot for each election without needing to reapply.
Signature Requirement Applicants must sign the application; if unable to do so, they may make a mark witnessed by another person.
Military and Overseas Voters Military and overseas voters should not use this application; they must apply using the Federal Postcard Application (FPCA).
Contact Information If the address of your county board of elections is not on the form, you can find it on the New York State Board of Elections website.

New York Absentee Ballot Application: Usage Guidelines

Once you have the New York Absentee Ballot Application form in hand, you will need to fill it out carefully. The information you provide will help ensure you receive your absentee ballot in a timely manner. Follow these steps to complete the application accurately.

  1. Begin by filling in the date of your application at the top of the form.
  2. Check the reason for your absentee ballot request. You can choose from options such as absence from the county, illness, or duties related to caregiving.
  3. Indicate which election you are requesting absentee ballots for by checking the appropriate box. Specify the dates of your absence if applicable.
  4. Provide your last name, first name, middle initial, and suffix in the designated fields.
  5. Enter your date of birth in the specified format.
  6. Fill in your county of residence, along with your phone number and email address (optional).
  7. Complete your residential address, including street, apartment number, city, state, and zip code.
  8. Choose your preferred method of delivery for the absentee ballot for both the Primary Election and the General (or Special) Election. You can select to pick it up in person or have it mailed to you.
  9. Sign the application to certify that you are a registered voter and that the information provided is accurate. Include the date of your signature.
  10. If you are unable to sign due to a disability, follow the instructions provided to make your mark and have it witnessed.

After completing the form, ensure it is returned to your county board of elections by the appropriate deadline. This will help you receive your absentee ballot and participate in the upcoming elections.

Your Questions, Answered

1. What is the process for applying for an absentee ballot in New York?

To apply for an absentee ballot in New York, you must complete the absentee ballot application form. You can submit your application in person or by mail. If delivering in person, ensure that your application reaches your county board of elections no later than the day before the election. If mailing your application, it must be received by your county board of elections no later than 15 days before the election.

2. What are the eligibility criteria for requesting an absentee ballot?

You may request an absentee ballot if you will be absent from your county or the City of New York on election day. Other reasons include being a resident or patient of a Veterans Health Administration Hospital, having a temporary or permanent illness or physical disability, being detained in jail or prison, or fulfilling duties related to the primary care of someone who is ill or physically disabled.

3. How can I ensure my absentee ballot is counted?

To ensure your absentee ballot is counted, return it by the close of polls on election day. You can personally deliver it to your county board of elections or mail it. If you choose to mail it, ensure it is postmarked by election day and received by the board of elections within seven days after the election.

4. Can someone else pick up my absentee ballot for me?

Yes, you can authorize someone else to pick up your absentee ballot. You must provide their name on the application form in the designated section. Make sure to check the appropriate box indicating that you authorize this individual to collect your ballot on your behalf.

5. What if I have a permanent illness or disability?

If you indicate that your illness or disability is permanent on your application, you will automatically receive an absentee ballot for each election in which you are eligible to vote. This means you will not need to apply again for future elections.

6. When will I receive my absentee ballot?

Your absentee ballot will be sent to you starting 46 days before federal, state, county, city, or town elections. If you apply after this date, your ballot will be sent immediately after your application is processed. If you provide specific dates indicating your absence, you will receive ballots for elections occurring within that timeframe.

7. What should I do if I have not received my ballot?

If you have not received your absentee ballot, contact your local county board of elections. They can provide you with information regarding the status of your application and ballot. It’s essential to follow up to ensure your ability to vote absentee.

Common mistakes

  1. Inadequate Clarity: Many applicants fail to print their information clearly. This can lead to misinterpretation of names, addresses, or other critical details.

  2. Missing Signature: Some individuals neglect to sign the application. Without a signature, the application may be deemed invalid.

  3. Incorrect Dates: Filling in the wrong dates for absence can result in complications. Ensure that the dates accurately reflect the intended timeframe.

  4. Improper Delivery Method: Applicants often misunderstand the delivery options. Knowing whether to submit in person or by mail is crucial for timely processing.

  5. Failure to Check Eligibility: Some people do not verify their eligibility for absentee voting. It’s important to confirm that you meet the necessary criteria before applying.

  6. Incomplete Information: Leaving out essential details, such as the county of residence or contact information, can hinder the application process.

  7. Choosing Multiple Elections Incorrectly: Applicants sometimes fail to indicate the specific elections for which they are requesting a ballot. This can lead to confusion and delays.

  8. Ignoring Witness Requirements: If assistance is needed to sign the application, the witness must be present. Ignoring this requirement can invalidate the application.

  9. Not Following Instructions: Each section of the application has specific instructions. Overlooking these can result in errors that may affect the application’s acceptance.

Documents used along the form

When applying for an absentee ballot in New York, several other forms and documents may be necessary to ensure a smooth voting process. Each of these documents serves a specific purpose and can help clarify your eligibility or assist with the absentee voting process. Below is a list of commonly used forms that accompany the New York Absentee Ballot Application.

  • Federal Post Card Application (FPCA): This form is designed for military members and overseas voters. It allows them to request absentee ballots and ensures they receive the necessary voting materials while away from their registered voting location.
  • Voter Registration Form: This document confirms that an individual is registered to vote in New York. It is essential to ensure that the voter’s information is up to date and accurate before applying for an absentee ballot.
  • Affidavit of Identity: In some cases, voters may need to provide an affidavit to confirm their identity when applying for an absentee ballot. This document serves as a sworn statement affirming the applicant's identity and eligibility to vote.
  • Absentee Ballot Tracking Form: This form allows voters to track the status of their absentee ballot. It provides updates on whether the ballot has been mailed, received, or counted, helping to ensure that the vote is properly recorded.
  • Witness Statement: If a voter is unable to sign the absentee ballot application due to a disability, a witness statement may be required. This document verifies that a witness observed the voter making their mark on the application.
  • Change of Address Form: If a voter has moved since their last registration, this form is necessary to update their address in the voter registration system. It ensures that ballots are sent to the correct location.

Understanding these additional forms can significantly ease the absentee voting process in New York. Being prepared with the right documentation ensures that voters can participate in elections, even when they cannot be present in person. Always check with your local board of elections for specific requirements and updates related to absentee voting.

Similar forms

  • Voter Registration Form: Like the absentee ballot application, this form requires personal information such as name, address, and date of birth. Both documents serve to verify a voter's eligibility and ensure accurate records are maintained by election officials.
  • Federal Post Card Application (FPCA): This form is specifically for military and overseas voters. It allows them to request an absentee ballot while providing similar personal information and a declaration of eligibility, paralleling the New York absentee ballot application process.
  • Vote by Mail Application: This document allows voters to request a mail-in ballot for elections. It shares similarities with the absentee ballot application in that it requires the voter to provide their address and reason for voting by mail.
  • Provisional Ballot Application: When a voter’s eligibility is in question, they may use this application to cast a provisional ballot. Both documents require the voter to affirm their identity and eligibility, ensuring that their vote can be counted once eligibility is confirmed.
  • Change of Address Form: When a voter moves, they must update their registration. This form, like the absentee ballot application, requires personal information and serves to maintain accurate voter rolls.
  • Election Day Registration Form: In some states, voters can register on Election Day. This form requires similar information to the absentee ballot application and serves to confirm a voter's eligibility at the polls.
  • Absentee Ballot Return Envelope: This envelope is used to return completed absentee ballots. It often includes instructions and requires the voter’s signature, similar to the application process where a signature is necessary to validate the request.
  • Ballot Application for Disabled Voters: This application is tailored for voters with disabilities, allowing them to request accommodations. It parallels the absentee ballot application by focusing on the unique needs of voters while gathering necessary personal information.
  • Election Assistance Commission (EAC) Forms: These forms are used for various election-related requests and often require the same basic information as the absentee ballot application, ensuring compliance with federal voting standards.
  • Candidate Nomination Petition: This document allows individuals to run for office and requires signatures from registered voters. Like the absentee ballot application, it aims to validate the identity and eligibility of those involved in the electoral process.

Dos and Don'ts

When filling out the New York Absentee Ballot Application form, there are several important things to keep in mind. Here’s a list of what you should and shouldn’t do:

  • Do print clearly. Your application must be easy to read to avoid any processing delays.
  • Do ensure you meet the eligibility requirements. You must be a registered voter to apply for an absentee ballot.
  • Do submit your application on time. Remember, it must be received by your county board of elections no later than 15 days before the election.
  • Do sign the application. Your signature is required to certify that the information provided is true and correct.
  • Don't use a power of attorney or preprinted name stamps. These are not allowed on the application.
  • Don't forget to check the appropriate boxes for the reason you are requesting an absentee ballot. This helps ensure your application is processed correctly.

By following these guidelines, you can help ensure that your absentee ballot application is completed correctly and submitted on time. This way, you can participate in the election even if you cannot be present on election day.

Misconceptions

Understanding the New York Absentee Ballot Application form is crucial for voters who may be unable to cast their ballots in person. However, several misconceptions can lead to confusion and hinder the voting process. Here are five common misconceptions:

  • Misconception 1: You can apply for an absentee ballot at any time.
  • Many people believe that they can apply for an absentee ballot whenever they choose. In reality, applications must be received by the county board of elections no later than 15 days before the election if submitted by mail. If delivered in person, the application must be submitted no later than the day before the election.

  • Misconception 2: You do not need a valid reason to request an absentee ballot.
  • Some voters think they can request an absentee ballot without providing a valid reason. However, the application requires individuals to check a specific reason for their absenteeism, such as illness or being out of the county on election day.

  • Misconception 3: Once you apply for an absentee ballot, you do not need to do anything else.
  • It is a common belief that applying for an absentee ballot is the final step. In fact, after receiving the ballot, voters must ensure it is completed and returned by the election day deadline. The ballot can be mailed or delivered in person to the board of elections.

  • Misconception 4: You can use a power of attorney to sign the absentee ballot application.
  • Some individuals assume that a power of attorney can be used to sign the absentee ballot application on behalf of a voter. This is incorrect. The voter must sign the application themselves or make a mark that is witnessed, as no preprinted name stamps or powers of attorney are permitted.

  • Misconception 5: You will automatically receive an absentee ballot for every election.
  • Many voters think that applying for an absentee ballot once guarantees they will receive one for all future elections. While individuals with a permanent disability may automatically receive ballots for future elections, most voters must apply for an absentee ballot for each election they wish to participate in absentee.

Key takeaways

When filling out and using the New York Absentee Ballot Application form, keep these key points in mind:

  • Submit Your Application on Time: Ensure that your application is delivered in person by the day before the election or mailed at least 15 days prior to the election.
  • Provide Accurate Information: Fill out the application clearly and truthfully. Any false statements can lead to serious penalties.
  • Check Eligibility for Automatic Ballots: If you have a permanent illness or disability, your application will allow you to receive ballots automatically for future elections without reapplying.
  • Designate a Representative if Needed: If you cannot pick up your ballot, you can authorize someone else to do so by completing the appropriate sections of the application.