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City of Haverhill
Massachusetts 01830
Registrars of Voters
City Hall, Room 118
Phone 978-374-2312

CERTIFICATE OF PERMANENT DISABILITY

 

___________________ ___, 2____

This is to Certify That ____________________________________________________________,

Residing at ___________________________________________________________________,

Is personally know to me, and that he/she is disabled and will be unable
to cas his/her vote in person at teh polling place on Election Day
Please Add this Voter to the abasentee Voter List
ch. 54 Sec 86

________________________
Physician

 
 
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Office of the Mayor
City of Haverhill, Massachusetts
City Hall, Room 100, 4 Summer Street, Haverhill, MA 01830
mayor@cityofhaverhill.com
978-374-2300

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