25 Pa. Stat. § 3146.6a
Any elector qualified to vote an official absentee ballot in accordance with the provisions of section 1301, subsection (k), may receive assistance in voting (1) if there is recorded on his registration card his declaration that he has a physical disability which renders him unable to see or mark the official absentee ballot, the exact nature of such disability being recorded on such registration card; (2) if such elector requiring assistance submits with his application for an official absentee ballot, a statement setting forth the precise nature of the disability which renders him unable to see or mark the official absentee ballot and that to the best of his knowledge and belief he will still suffer from the said physical disability at the time of voting his official absentee ballot. He shall acknowledge the same before an officer qualified to take acknowledgement of deeds. Such statement shall be in substantially the following form:
Statement of Absentee Elector Requiring Assistance
| I, | .............................................................................................................................., | hereby state |
| (Name of voter requiring assistance) |
that I require assistance in marking the official absentee ballot for the primary or election held .................................................................................., 19..., that will be issued to me
(Date)
for the following reasons:
.........................................................................................................................................................................
(Insert nature of disability)
| .................................................................................... | |
| (Signature or mark of elector) | |
| ............................................................................... | |
| (Date of signature or mark) | |
| Commonwealth of Pennsylvania: | |
| ss | |
| County of :..................................................: |
On this .......... day of .........., 19...., before me, ...................., the undersigned officer personally appeared ...................., known to me (or satisfactorily proven) to be the person whose signature or mark appears on the within instrument and acknowledged the same for the purposes therein contained.
In witness whereof, I have hereunto set my hand and official seal
| .................................................................................... |
| (Title of Officer) |
Upon receipt of the official absentee ballot, such elector requiring assistance may select a person to assist him in voting, such assistance to be rendered in secret: Provided, however, That the person rendering assistance may not be the elector's employer or an agent of the employer or an officer or agent of the elector's union. The person rendering the assistance in voting shall complete, date and sign the declaration in such form approved by the Secretary of the Commonwealth, or substantially in the form as set forth below, that the person has caused the elector's ballot to be marked in accordance with such elector's desires and instruction. Such declaration form shall be returned to the county board of elections in the mailing envelope addressed to the county board of elections within which the small "official absentee ballot" is returned.
Declaration of Person Rendering Assistance
| I, | ,................................................................................................................................................................, |
| (Name of Person rendering assistance) |
hereby declare that I have witnessed the aforesaid elector's signature or mark and that I have caused the aforesaid elector's ballot to be marked in accordance with the desires and instructions of the aforesaid elector.
| ..................................................................................... |
| (Signature of Person Rendering Assistance) |
| ..................................................................................... |
| (Address) |
25 P.S.§ 3146.6a