ELECTION MATERIAL
PLEASE EXPEDITE
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On one side of such envelope shall be printed:
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OFFICIAL BALLOT, ABSENTEE VOTER
TOWN OF SULLIVAN
SPECIAL TOWN ELECTION - DATE
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Name of Voter
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Post Office Address
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Owner of Parcel (s) SBL #
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The date of the election shall be printed, and the name of the
voter, address and parcel(s) SBL # shall be completed.
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STATEMENT OF ABSENTEE VOTER
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I do declare that I am a citizen of the United States and will
be at least 18 years of age on the date of the special Town election;
that I will be unable to appear personally on the day of the special
Town election at the polling place in which I am a qualified voter
because of the reason stated at the time of my request for an absentee
ballot; that I have not, nor do I intend to vote in person; that I
have not committed any act nor am I under any impediment which denies
me the right to vote.
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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 absentee voter,
I shall be guilty of a misdemeanor.
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Date
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Signature of Voter
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