N.Y. Comp. Codes R. & Regs. tit. 19, § 335.1 – The ballot envelope.

(a) The ballot envelope shall be printed as follows:
BALLOT FOR MILITARY VOTER, NOVEMBER 2, 1976—STATEMENT
I do state (or affirm) that I am MUST CHECK ONE
(a) [ ] in the actual military service of the state, or of the United States
(b) [ ] the spouse
(c) [ ] parent
(d) [ ] child
of a voter in the actual military service of the state, or of the United States, accompanying or being with him or her and a resident of the same election district; and that on the date of the next general election I will be at least eighteen years of age and immediately preceding said date will have been a citizen of the United States, a resident of the State of New York and of the county, city or village in which I offer my vote for thirty days, and that I have not received or offered any compensation or reward for the giving or withholding of a vote at this election; that I have not made or become interested in any wager depending upon the result of this election; that I have not voted any other ballot for any candidate from any address other than hereinafter set forth; and that I have not been convicted of bribery or any infamous crime; or if so convicted, that I have been pardoned or my right of suffrage restored.
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)
(b) On the reverse side of the ballot envelope containing the statement of the military voter shall be printed:
1. TO BE FILLED IN BY BOARD OF ELECTIONS:
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.
2. After marking ballot, fold and enclose it in this envelope, and seal it. SIGN STATEMENT THEREON. Enclose this sealed envelope in the larger envelope addressed to the Secretary of State of N. Y., Division for Servicemen's Voting, which must receive same not later than 12 o'clock noon on November 1, 1976.