"AGENT AUTHORIZATION FORM
If applicable, fill out and sign this form and place it in the Return Envelope
I hereby authorize ...............(insert his or her name) as my authorized agent, to deliver this ballot as I am medically unable to vote on election day. An affidavit verifying my medical status as unable to deliver the application or to vote on the day of the election is attached or has been provided with my application.
...............
Signature of voter
...............
Printed name of voter
...............
Address of voter
...............
Date of birth of voter."
Ark. Code § 7-5-409