Onondaga County, New York



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ALL APPLICANTS MUST SIGN BELOW (Signature by ‘Power of Attorney’ will not be accepted)

I certify that the information in this application is true and correct and understand 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_______________________________________________________ Date__________________________

Filling out this form electronically by typing in your name will suffice in completing this form. Failure to sign this form will not prevent the BOE from processing your form. All applicants must sign the oath envelope mailed to you with your ballot for your ballot to be processed.

I AM REQUESTING AN ABSENTEE BALLOT DUE TO: (mark x next to selection)

____ Absent from County ____ Temporary illness or Disability

(to be used for COVID-19 crisis for June 23rd Primary only)

____ Primary Caregiver for ill or disabled person(s) ____ Permanent illness or Disability

*A Permanent absentee status qualifies you

____ Detention in jail awaiting action by grand jury or a to automatically receive an absentee ballot for

Trial or confined in jail for an offense other than a felony each election you qualify for without a new application

By filling out this form you are requesting an Absentee Ballot for the June 23rd, 2020 Primary. If you wish to get an Absentee Ballot for the General Election on November 3rd you must mail in an application.

Name: _________________________________________________________ Date of Birth: _______________________

Phone: _____________________________ E-mail: _______________________________________________________

Residence Address: __________________________________________________________________________

Mail Ballot to this Address: (Ballots are mailed approximately 3 weeks before each Election)

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

I designate the following person to pick up my ballot: __________________________________________________________________

EMAIL APPLICATION FORM

Applications must be signed and delivered to the Onondaga County Board of Elections not later than 5:00 pm the day before Election Day or postmarked not later than seven (7) days before the Election. This form can be emailed to absentee@ for the June 23rd primary only.

TIME STAMP

( Voted in office

( Ballot taken

Staff Initials

FOR OFFICE USE ONLY

Party _____________________________

Registration #_______________________

Ward/Town/Dist_____________________

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