(a)

(1) Applications for absentee ballots may be made on a form or forms prescribed by the Secretary of State and furnished by the county clerk at least sixty (60) days before the election.

(2) The form or forms shall contain the following information:

(A) The following statement:

"IF YOU PROVIDE FALSE INFORMATION ON THIS FORM, YOU MAY BE GUILTY OF PERJURY AND SUBJECT TO A FINE OF UP TO $10,000 OR IMPRISONMENT FOR UP TO 10 YEARS.";

(B) A statement in which the voter must indicate that he or she is requesting an absentee ballot because he or she will be:

(i) Unavoidably absent from the polling site on election day;

(ii) Unable to attend the polls on election day because of illness or physical disability; or

(iii) Unable to attend the polls on election day because of residence in a long-term care or residential facility licensed by the state;

(C) A statement by the voter indicating whether he or she resides outside the county;

(D) A statement indicating whether the voter is a United States citizen residing outside the territorial limits of the United States;

(E) A statement indicating whether the voter is in active service as a member of the armed services of the United States;

(F) Mailing information for the ballot or the name and signature of a designated bearer, an administrator, or an authorized agent;

(G) The date, the voter's printed or typed name, voting residence address, date of birth, and the voter's signature attesting to the correctness of the information provided under penalty of perjury; and

(H) The election in which the voter wishes to cast an absentee ballot.

(3)

(A) The form or forms shall contain a portion to include a sworn statement that may be completed by a voter stating that the voter is registered to vote and that he or she is the person who is registered.

(B) The sworn statement portion of the form or forms under subdivision (a)(3)(A) of this section is not required to be notarized but shall be executed by the voter under penalty of perjury.

(b) The Secretary of State may prescribe separate absentee ballot application forms for:

(1)

(A) Persons who reside within the county in which they are registered to vote and will be unavoidably absent from the polls on the date of the election.

(B) The application shall be valid for one (1) election cycle, which includes any one (1) election and the corresponding runoff election;

(2)

(A) Persons whose application would be valid for one (1) calendar year.

(B) This includes the following:

(i) Persons who reside outside the county in which they are registered to vote;

(ii) Persons in long-term care or residential facilities licensed by the state; and

(iii) Voters with disabilities; and

(3) Persons whose applications would be valid through the next regularly scheduled general election for federal office, including any resulting runoff elections.

(c) Any person may distribute blank applications for absentee ballots.