SPIRO T. AGNEW, Governor                       935

This is to certify that in the opinion of the undersigned attending

physician......................................who resides at......................................

(name of voter)
is mentally competent to vote in the................................Election to be

held on..........................................................................and that because

of illness or injury the voter is now, or will be prevented from per-
sonally voting at said election.

..................................................................Reg. No.....................................

(Physician)

(Address)

(c) The application for all other absentee voters shall be in the
following form:

(Date)

Board of Supervisors of Elections of..................(County or Baltimore

City):

I,............................................................, hereby apply for a Maryland

(Print Name)

Absentee Ballot for the Election to be held on........................................

(Date of Election)

I will not be able to vote in person because..........................................

(State reason)

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

(No. and Street or RFD)

town or village of.............................., in the County of..........................,

Maryland, and my voting district (or ward) and precinct to the best

of my knowledge is..............................................................

I am now registered as........................................................

(Party or Decline)

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

(Sign Name)

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

of.....................................19............

(Notary Public or other person author-
ized to administer oaths)

Warning: An absentee ballot will not be sent to you unless you are
registered to vote in elections in this State.

27-6. Determination of absentee voter's applications; delivery of
ballots.

(a) Upon receipt of an application containing the affidavit, the
board shall reject the application only upon the unanimous vote of