Application must be received by the District Clerk at least 7 days before the election if the ballot is to be mailed to the voter, or the day before the election, if the ballot is to be delivered personally to the voter.
State of New York
City of Glen Cove
County of Nassau
I, ............................................................................................................... being affirmed say:
I reside at ..................................................................................................Glen Cove, NY 11542
I am a qualified voter of the Glen Cove School District, in which I reside, in that
□ I am or will be on such date over 18 years of age, a citizen of the
United States, and have or will have resided in Glen Cove for thirty days next
preceding such date.
□ I am registered in the district.
I will be unable to appear to vote in
person on the day of the school district election for which the absentee ballot
is requested because I am or will be on such day:
(Complete one of the
following)
□
A.
A patient in a hospital or unable to appear personally at the
polling place on such day because of illness or physical disability.
□ B. Because my duties, occupation, business, or studies will require me to be outside of the county or city of my residence on such day.
□ Where such duties, occupation, business, or studies are of such a nature as ordinarily to require such absence, a brief description of such duties, etc. shall be set forth (description)
.............................................................................................................................................................................□ Where such duties, occupation, business, or studies are not of such a nature as ordinarily to require such absence, a statement much be given for the special circumstances to account for such absence (statement).......................................................................................................................................
□
C. I will be on vacation elsewhere on such day.
I expect that such vacation will begin on.......................
and
end on................................... and will be at the following place or places. ........................................
Name of employer....................................................................... address........................................................
Or self employed as a..................................................................located at.........................................................
Or retired as..................................................................................
□
D. I will be absent from my voting residence because
□ I am detained
in jail
waiting action by a grand jury,
□
I am awaiting trial,
□ I am confined in a prison
after conviction for an offense other than a felony.
□
E. I will be absent from the school district on the day of the election by
reason of being with the
□ spouse,
□
parent, or □
child of,
and reside in the same household with, a person qualified to apply
because that person will be
□ absent from the county
of his residence due to his duties, occupation, business, or studies and such
absence is not caused by the fact that his regular daily place of business of
studies is located outside such county, or
□ absent due to vacation,
□ a
patient at a hospital,
□ detained in jail,
□ confined
due to illness or physical disability.
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 statements in the foregoing statement of application for absentee ballots, I shall be guilty of a misdemeanor.
Date............................................................Signature or mark of voter ....................................................................................