Soldiers from the Town of Lee who were eligible to vote in the general election were required to fill out the following form and forward it to the town.

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The said absent elector shall make an subscribe the following affidavit:

I __________________________ do solemnly swear (or affirm) that I have been a citizen of the United States for ten days, am now of the age of twenty one years, that I have been or shall have been an inhabitant of the State of New York for one year next preceding the election to be held on the ___________ day of _____________, 186_, for the last four months a resident of the county of ________________ for thirty days next preceding said election a resident of the town (or city) of ______________________ and that I am now, and until said election, intend to be a resident there of ; that I have not made any bet or wager, and am not directly or indirectly interested in any bet or wager depending upon the result of said election and I do further swear, that I am in the actual military (or naval) service of the United States, that I am now a member of company _____ of the ____________________ Regiment of ______________________ now at or near __________________________ in the state (or territory) of _________________(or attached to the Unites States vessel ________________________).

Sworn to and subscribed this _______ day of _________ 186__ before me ________________.

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• Adams, Benjamin from Fort Harrison, Va.
• Adams, Charles from Petersburg, Va.
• Allen, George from Fort Brady, Va
• Aucutt, Joseph from Fort Brady, Va.
• Bathrick, Robert from Harpers Ferry
• Bliss, William from City Point, Va.
• Brady, Patrick from City Point, Va.
• Brown, Charles from Sandy Hook, Md.
• Bushnell, Theaphilus from Fort Harrison, Va.
• Castle, John J from Chapins Bluff, Va
.
• Chapman, Orrin P from Middletown, Va.
• Cleveland, Charles from Richmond, Va.
• Cornish, George from Fort Harrison, Va.
• Cornish, Charles from Petersburg, Va.
• Countryman, Jerimiah P from Petersburg, Va.
• Delino, Delanzo D from Richmond, Va.
• Demming, Andrew W from Lima, Ohio
• Dunbar, Marcus from Fort Brady, Va.
• Eames, James C from Petersburg, Va.
• Ennis, Joshua from Petersburg, Va.
• Ennis, Orrin from Fort Harrison, Va.
• Fox, Henry from Fort Brady, Va.
• Gillett, Esham from Harper, Ferry, Va.
• Graham, Horace R from Middletown, Va.
• Howe, John from Petersburg, Va.
• Ingersall, Frank D from City Point, Va.
• Kingsbury, Hezikiah from Richmond, Va.
• Mayhew, William M from Fort Harrison, Va.
• Miles, Stephen S from Fort Harrison, Va.
• Miller, Henry N from Fort Harrison, Va.
• Myers, Wait M from Fort Harrison, Va.
• Myers, Albert from Fort Harrison, Va.
• New, Henry E from Fort Harrison, Va.
• Nickleson, Charles from City Point, Va.
• Penfield, J Eugene
• Platter, Matthew from Petersburg, Va.
• Pooler, Orville M from Fort Harrison, Va.
• Pratt, Merwin S from Fort Harrison, Va.
• Satterly, Addison from Fort Harrison, Va.
• Sheer, George H from City Point, Va.
• Skinner, Edwin from Petersburg, Va.
• Tanner, Reuben R from City Point, Va.
• Ufford, Julian C from Fort Jefferson, Florida
• Washburn, Albert from Douglas Hospital, Washington D.C.
• Webster, Madison from Harpers Ferry, Md.
• Willson, Erastus R from Fort Harrison, Va.