934                             LAWS OF MARYLAND                      [CH. 392

I am not now registered and I will be 21 years old or older on

...................................................., and

(Date of Election)

I wish to be registered as......................................

(Party or Decline)

I desire that the ballot be sent to me at the following address:

(Sign name)

(Military rank or other status if any, or
the spouse of)

(Military Rank or other status)

Subscribed and sworn to (or affirmed) before me this................day

of................,19............

(Notary public or other person author-
ized to administer oaths; commissioned
officer, non-commissioned officer, not
below the rank of sergeant, or petty of-
ficer, other than applicant; if in Merchant
Marine, certifying officer may be a mas-
ter, first officer, chief engineer or purser;
or an ambassador, minister, charge d'af-
faires, counselor to or secretary of a lega-
tion, consul general, consul, vice-counsul,
commercial attache, or consular agent of
the United States accredited to the coun-
try where the acknowledgment is made;
or a notary public of the country where
the acknowledgment is made; or a judge
or clerk of a court of record of the coun-
try where the acknowledgment is made.

(2) Any qualified voter who is unable to vote in person because
of physical disability shall complete the medical certificate required
by Sec. 27-2 of this Article, which shall be in substantially the follow-
ing form and which certificate shall be filed with the boards at the
same time this application is returned to the boards:

SUPERVISORS OF ELECTIONS

OF................................................

(Baltimore City or County)

(Address)
CERTIFICATE OF PHYSICIAN

(THIS CERTIFICATE MUST BE RECEIVED AND FILED AT
OUR OFFICE NOT LATER THAN TEN (10) DAYS PRIOR TO
THE ELECTION)