MARVIN MANDEL, Governor                        705

(Notary public or other person au-
thorized to administer oaths; com-
missioned officer, noncommissioned
officer, not below the rank of ser-
geant, or petty officer, other than
applicant; if in Merchant Marine,
certifying officer may be a master,
first officer, chief engineer or purser;
or an ambassador, minister, charge
d'affaires, counselor to or secretary
of a legation, consul general, consul,
vice-consul, commercial attache, or
consular agent of the United States
accredited to the country where the
acknowledgment is made; or a notary
public of the country where the ac-
knowledgment is made; or a judge or
clerk of a court of record of the
country where the acknowledgment is
made.]

Warning! The Absentee Voting Law provides that anyone who
wilfully signs any false application or oath, or who wilfully does
any act contrary to the terms and provisions of the Absentee Voting
Law with intent to cast an illegal vote or to aid another in doing so,
or who wilfully violates any of the provisions of that law or who
applies for a ballot under any other name than his own, shall, upon
conviction, be subject to a fine of $1,000 or to imprisonment for not
more than two years, or to both, in the discretion of the court.

(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 Absentee

(Print Name)

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)