APPLICATION FOR ABSENTEE BALLOT 10 ILCS 5/19-3,29-10
SBE no. A-7
To be voted at the Primary Election to be held March 20, 2012 in the County
of Bureau and State of Illinois. I state that
I am a resident of Precinct _________________ in the township of _________________or
City/Village of _________________ residing at
_________________________________________________________________________ in such city or
town in the County of Bureau and State of Illinois; that I have lived at such
address for _______months last past; that I am lawfully entitled to vote in such
precinct at the above-named election to be held therein, and that I wish to
vote by absentee ballot.
I hereby make application for an official ballot or ballots to be voted by me at
such election, and I agree that I shall return such ballot or ballots to the
official issuing the same prior to the closing of the polls on the date of the
election or, if returned by mail, postmarked no later than midnight preceding
election day, for counting no later than during the period for counting
provisional ballots, the last day of which is the 14th day following election
day.
Under penalties as provided by law pursuant to 10ILCS 5/29-10, the
undersigned certifies that the statements set forth in this application are true
and correct.
Post office address to which ballot is I request ballot for: ______________Party.
to be mailed: (if for Primary)
______________________________________________ _______________________________________
(Signature of Applicant)
______________________________________________
________________________________________
______________________________________________ (name of Applicant - please print)
Include phone # or email in case we need ______________________________
to contact you._____________________________________ Date of Birth
Return completed application to Bureau County Clerk, 700 South Main St.,
Princeton, IL 61356. Applications must be received in the office of the county
clerk not later than 5 days prior to election day.