Inner envelope for return of ballot; statement under false statement penalty.

“I hereby state under the penalties of false statement in absentee balloting that I am eligible to vote at the primary, election or referendum in the municipality in which this absentee ballot is to be cast and that I expect to be unable to appear at my polling place on the day of such primary, election or referendum for one or more of the following reasons: (1) My active service in the armed forces; (2) my absence from the town in which I am eligible to vote; (3) sickness; (4) physical disability; (5) the tenets of my religion which forbid secular activity on the day of such primary, election or referendum; or (6) my duties as a primary, election or referendum official. Date .... .... (Signature)” See Sec. 9-14a re electors in custody of state. Cited. 231 C. 602. Cited. 28 CS 361.