New York Codes, Rules and Regulations
Title 8 - EDUCATION DEPARTMENT
Chapter II - Regulations of the Commissioner
Subchapter E - Elementary and Secondary Education
Part 122 - Military Ballots for School District and School District Public Library Elections, Budget, and Referenda
Section 122.8 - Military ballot voter information

(a) On one side of the envelope shall be printed or permanently fixed:

OFFICIAL BALLOT, MILITARY VOTER

for

School District or School District Public Library Election, Budget Vote or Referenda

Name of Voter.......................

District Residence (street and number, if any)...........

City (or Town) of......................

County of........................

School District ..........

School Election District (if applicable)..............

The date of the election, budget vote or referenda and name of the school district or school district public library, as applicable, shall be printed and the name of the voter, residence, school election district (if applicable) shall be written in by the board of registration, in school districts that provide for personal registration of voters; the school district clerk, in school districts that do not provide for personal registration; or the appropriate official designated by school district public libraries, as applicable.

(b) On the reverse side of such envelope shall be printed or permanently fixed the following statement:

STATEMENT OF MILITARY VOTER

I do declare that I am a citizen of the United States, and will be at least eighteen years of age, on the date of the school district and/or school district public library election, budget vote or referenda for which I submit this military ballot; that I will have been a resident of this state and of the school district and school election district, if any, shown on the reverse side of this envelope for thirty days next preceding the said election, budget vote or referenda and that I am or on such a date will be, a qualified voter of said school district and/or school district public library; that I will be unable to appear personally on the day of said school district election, budget vote or referenda at the polling place of the said district in which I am or will be a qualified voter because of the reason stated on my application heretofore submitted; that I have not qualified, nor do I intend to vote, elsewhere than as set forth on the reverse side of this envelope; that I have not received or offered, do not expect to receive, have not paid, offered or promised to pay, contributed, offered or promised to contribute to another to be paid or used, any money or other valuable thing, as a compensation or reward for the giving or withholding of a vote at this school district and/or school district public library election, budget vote or referenda, and have not made any promise to influence the giving or withholding of any such votes; that I have not made or become directly or indirectly interested in any bet or wager depending upon the result of this school district and/or school district public library election, budget vote or referenda; and that I have not been convicted of bribery or any infamous crime, or, if so convicted, that I have been pardoned or restored to all the rights of a citizen, without restriction as to the right of suffrage, or have received a certificate of relief from disabilities or a certificate of good conduct pursuant to article twenty-three of the correction law removing my disability to register and vote. 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 statement in the foregoing statement of military voter, I shall be guilty of a misdemeanor.

Date ..................... Signature of Voter ..........................