A qualified voter desiring to vote at any such election as an absentee voter shall make application in writing to the board of supervisors of elections for an absentee ballot, not later than seven (7) days before such election and such application shall be made under penalty of perjury and shall set forth:

(a) His or her name and residence address, including the street and number, if any;

(b) That he or she is a qualified voter at the residence given;

(c) In case he or she voted at the preceding election, the residence from which he or she so voted;

(d) That he or she expects in good faith to be unable to vote in person on the day of the next regular or special election for whatever reason, specifying it.