4 Pa. Code § 171.16
Form of affidavit for absentee ballot registration.
3 Pa.B. 1721
The following form of affidavit for absentee ballot registration due to illness or permanent physical disability is attached hereto and made a part of this section:
Physician’s Certificate of Permanent Disability
I hereby certify that the above named voter is permanently disabled, and either physically unable to attend the polls or physically unable to operate a voting machine (or mark the ballot) and to orally request assistance to do so.
| (Date) | (Signature of Physician) |
SHOULD YOU LOSE YOUR DISABILITY, YOU MUST INFORM THE COUNTY BOARD OF ELECTIONS OF THE COUNTY WHEREIN YOU RESIDE.
Source
The provisions of this § 171.16 adopted August 17, 1973, 3 Pa.B. 1721.