I hereby swear (or affirm) that I am unable to register in person by reason of absence from my election district, that on the day of the next ensuing election I shall have been a citizen of the United States for at least one month, that I will be 18 years of age, on the day after the election, that I will have been a resident of the Commonwealth and my election district for at least thirty (30) days, that I will be legally qualified to vote, and that I have read (or have had read to me) the foregoing statements made in connection with my registration and that they are true and correct.
4 Pa. Code § 171.12