The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02

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Here is the text we could read:

Home Address: 
                                                                (Number)                         (Street)                                            (City)                                                   (State)                                   (Zip Code)             
Telephone Number: Home:                                                                            Work: 

   

APPLICANT’S  
AFFIDAVIT OF DISABILITY 
(Type or Print) 

 

 

tate of Alabama 

Unified Judicial System 

orm PERS-60      Rev. 4/07        

ame: 

Present Position: 

Date of Birth: 

Spouse’s Date of Birth: 

Date of onset of illness or injury causing present disability:  

Are you now totally disabled and unable to work?  

If “yes” give date of disability: 

Date last worked: 

Nature of illness or injury upon which disability retirement is being claimed:  

  S

  F

  N

                               

 

 

orm PERS-60  (back) 

APPLICANTS AFFIDAVIT OF DISABILITY 

hysicians consulted since onset of disability: 

Name 

Address 

ate of first treatment: 

Physician: 

If hospitalized for disabling disease/illness/injury give names of hospitals: 

 
 
 
 
 

 
 
 
 
 
 

 
 
 
 
 
 

ate your current term ends: 

Last election in which you were a candidate for office: 

id you lose? 

THE ABOVE ANSWERS ARE TRUE AND COMPLETE ACCORDING TO THE BEST OF MY KNOWLEDGE AND BELIEF. 

NOTE: Any person who knowingly files an Affidavit/Statement of Claim containing 
              any false or misleading information is subject to criminal and civil penalties 

worn to and subscribed before me this 

Date: 
                                                                                                            Applicant’s Signature 

otary Public                                                                                                                            Applicant’s Name (please print or type) 

 

 

  F

 

  P

 

  D

 

 
 
 
 
 

 
 
 
 
 
 

  D

  D

   

    S

    N

Applicant's Affidavit of Disability

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Alabama state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from eforms.alacourt.gov (2023-03)
Page(s): 2
Fields(s): 65
Average fields per page: 32
Reading Level: Grade 10
LIST Grouping(s): HE-00-00-00-00.

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Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

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text__3 was Text3 (0.35 conf)
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text__5 was Text5 (0.35 conf)
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text__7 was Text7 (0.35 conf)
text__8 was Text8 (0.35 conf)
text__9 was Text9 (0.35 conf)
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text__11 was Text11 (0.35 conf)
text__12 was Text12 (0.35 conf)
text__13 was Text13.0 (0.35 conf)
text__14 was Text13.1 (0.35 conf)
text__15 was Text13.2 (0.35 conf)
text__16 was Text13.3 (0.35 conf)
text__17 was Text13.4 (0.35 conf)
text__18 was Text13.5 (0.35 conf)
text__19 was Text13.6 (0.35 conf)
text__20 was Text13.7 (0.35 conf)
text__21 was Text13.8 (0.35 conf)
text__22 was Text13.9 (0.35 conf)
text__23 was Text13.10 (0.35 conf)
text__24 was Text13.11 (0.35 conf)
text__25 was Text13.12 (0.35 conf)
text__26 was Text13.13 (0.35 conf)
text__27 was Text13.14 (0.35 conf)
text__28 was Text13.15 (0.35 conf)
text__29 was Text13.16 (0.35 conf)
text__30 was Text14.0 (0.35 conf)
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text__33 was Text14.3 (0.35 conf)
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text__35 was Text16.0 (0.35 conf)
text__36 was Text16.1 (0.35 conf)
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text__38 was Text16.3 (0.35 conf)
text__39 was Text16.4 (0.35 conf)
text__40 was Text17 (0.35 conf)
text__41 was Text18 (0.35 conf)
text__42 was Text19.0.0 (0.35 conf)
text__43 was Text19.0.1 (0.35 conf)
text__44 was Text19.0.2 (0.35 conf)
text__45 was Text19.1.0 (0.35 conf)
text__46 was Text19.1.1 (0.35 conf)
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text__48 was Text19.2.0 (0.35 conf)
text__49 was Text19.2.1 (0.35 conf)
text__50 was Text19.2.2 (0.35 conf)
text__51 was Text19.3.0 (0.35 conf)
text__52 was Text19.3.1 (0.35 conf)
text__53 was Text19.3.2 (0.35 conf)
text__54 was Text19.4.0 (0.35 conf)
text__55 was Text19.4.1 (0.35 conf)
text__56 was Text19.4.2 (0.35 conf)
text__57 was Text19.5.0 (0.35 conf)
text__58 was Text19.5.1 (0.35 conf)
text__59 was Text19.5.2 (0.35 conf)
text__60 was Text20 (0.35 conf)
text__61 was Text21 (0.35 conf)
text__62 was Text22 (0.35 conf)
text__63 was Text23 (0.35 conf)
text__64 was Text24 (0.35 conf)
text__65 was Text25 (0.35 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Applicant's Affidavit of Disability

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Identified Data Fields:

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02