BALLOT FOR MILITARY VOTER, NOVEMBER 2, 1976--STATEMENT
I do state (or affirm) that I am MUST CHECK ONE
My voting address in the State of New York is:
Street and Number, or R.F.D............
City, Village or Town............
County............
I hereby declare that the foregoing is a true statement to the best of my knowledge and belief.
Sign________ Date............
(Voter must sign here)
County of____________
Name of Voter____________
Voting Address (street & number, if any)____________
City (or town) of________ Ward____________
Assembly District________ Election District____________
IMPORTANT TO MILITARY VOTER: Be sure to indicate in (a), (b), (c), or (d) whether you are a serviceman or the spouse, parent or child of a serviceman in the statement before you sign your name at the end of the statement. YOU MUST SIGN THE STATEMENT ON THE REVERSE SIDE OF THIS ENVELOPE.
N.Y. Comp. Codes R. & Regs. Tit. 19 § 335.1