proof of identification.
The election officer shall examine the proof of identification presented by the elector and sign an affidavit stating that this has been done.
I do solemnly swear or affirm that my name is __________, that my date of birth is __________, and at the time that I registered I resided at __________ in the municipality of __________ in __________ County of the Commonwealth of Pennsylvania and that this is the only ballot that I cast in this election.
Signature of Voter/Elector
Current Address
Check the Reason for Casting the Provisional Ballot.
Signed by Judge of Elections and minority inspector
25 P.S. § 3050