(a) I am a United States citizen residing outside the United States, and

(b) I am at least eighteen years of age (or will be by the day of the election), eligible to vote in the requested jurisdiction, and

(c) I have neither been convicted of a felony or other disqualifying offense nor been adjudicated mentally incompetent, or if so, my voting rights have been reinstated, and

(d) I am not qualified to register, request a ballot, or vote in any other jurisdiction in the United States, and

(e) My signature and date below indicate when I completed this document, and

(f) The information on this form is true and complete to the best of my knowledge. * I understand that a material misstatement of fact in the completion of this document may constitute grounds for conviction of a crime. Date......... 20...... ............................... Signature or mark of voter ............................... Signature of Witness (required only if voter does not sign his own name) ............................... Address of Witness * NB Effective until July 1, 2020 * I understand that a material misstatement of fact in the completion of this document may constitute grounds for conviction of a crime. Date.................20..... ..................................... Signature or mark of voter ..................................... Signature of Witness (required only if voter does not sign his or her own name) ..................................... Address of Witness * NB Effective July 1, 2020 3. On the reverse side of the inner affirmation envelope shall be printed: TO BE FILLED IN BY THE BOARD OF ELECTIONS FOR..........ELECTION......... 20...... Name of voter .......................................................... Residence from which vote is being cast: Street and number .................................................... City or town ......................................................... County ............................................................... Assembly District or Ward ............................................ Election District .................................................... Party Enrollment (in case of primary election) ....................... IMPORTANT TO SPECIAL FEDERAL VOTER: YOU MUST SIGN THE AFFIRMATION ON THIS ENVELOPE. 4. The information in subdivision three of this section shall be filled in by the board of elections prior to the mailing of any special federal ballot and envelopes if the special federal voter's preferred method of transmission with the board of elections is by mail, or it may be filled in by the board of elections upon receipt of the returned special federal ballot and envelope when the ballot and envelope have been transmitted to the special federal voter other than by mail or in person. 5. The inner affirmation envelope, if delivered by mail or in person, shall be gummed and ready for sealing. Such envelope, or any created by the special federal voter whose ballot was delivered by facsimile transmission or electronic mail in accordance with subdivision six of this section, shall have printed thereon, on the side opposite the affirmation, instructions as to the duties of the voter after the marking of the ballot. Such instructions shall include specific directions stating that the ballot must be returned in person or mailed to the appropriate board of elections, when the outer envelope must be postmarked, if mailed, and when such envelope, whether returned in person or mailed, must reach such board of elections in order to be canvassed. Such inner affirmation envelope shall also include a direction that an application for a special federal ballot should not be enclosed in the inner affirmation envelope containing such ballot. 6. If a special federal voter has designated a preference to receive his or her ballot by facsimile transmission or electronic mail pursuant to section 11-203 of this chapter, the transmission of the special federal voter's ballot shall include, together with all information and instructional materials that accompany ballot materials sent by the board of elections to other absentee voters, appropriate instructions as to the folding of same so as to create an envelope containing all of the information set forth in subdivisions two, three and five of this section. 7. Such inner affirmation envelope containing the special federal ballot shall be enclosed in an outer envelope addressed to the appropriate board of elections, and bearing on it the words "Official Election Ballot--Via Air Mail". The outer envelope shall include specific directions that if an original completed application for a special federal ballot has not already been delivered or mailed to the special federal voter's board of elections, such application must be completed by the special federal voter and returned in the outer envelope with the sealed inner affirmation envelope containing the special federal ballot within the time limits for the receipt of the special federal ballot itself. Such envelope shall provide lines in the upper left corner for the special federal voter to write his or her name and complete special federal address. 8. The outer envelope addressed to the appropriate board of elections and the inner affirmation envelope which contains the ballot shall be mailed to the special federal voter in a third envelope on which is printed the words "Official Election Ballot--Via Air Mail". 9. If the special federal voter's preferred method of transmission is facsimile transmission or electronic mail, the electronic transmittal of the special federal voter's ballot materials shall include appropriate instructions as to the folding of same so as to create an outer envelope containing all of the information set forth in subdivision eight of this section.