THEODORE R. McKELDIN, GOVERNOR 11

Absentee Resident, and on which such Absentee Resident may
apply for an Absentee Ballot, which said application shall be
in the following form:

Date
Board of Supervisors of Elections of Baltimore City:

I,........................, hereby apply for a Baltimore

(Print Name)

City Absentee Ballot for the municipal primary election (or
general election, as the case may be) to be held on............

..................., 19.....

My home address is........................., in the City

No. and Street

of Baltimore, State of Maryland, and my voting district (or
ward) and precinct to the best of my knowledge is..........

I desire to be registered as.............................

(If not now registered, indicate party affiliation desired. If
no party is indicated, you will not be permitted to vote in
the municipal primary election. )

I will be 21 years or older on the day of said election.

I desire that the ballot be sent to me at the following ad-
dress:

(Sign Name)
(Military Rank or other status)

Signature Certified by:

(To be signed by any commissioned
officer, non-commissioned officer, not
below the rank of sergeant, or petty
officer. )

(Rank). "

(b) The foregoing shall be printed on one side of a card, and
on the opposite side of the card shall be printed "Board of
Supervisors of Elections of Baltimore City", Baltimore, Mary-
land.